title: The role of area-level deprivation and gender in participation in population-based faecal immunochemical test (FIT) colorectal cancer screening.
abstract: This study aimed to investigate the effects of sex and deprivation on participation in a population-based faecal immunochemical test (FIT) colorectal cancer screening programme. The study population included 9785 individuals invited to participate in two rounds of a population-based biennial FIT-based screening programme, in a relatively deprived area of Dublin, Ireland. Explanatory variables included in the analysis were sex, deprivation category of area of residence and age (at end of screening). The primary outcome variable modelled was participation status in both rounds combined (with "participation" defined as having taken part in either or both rounds of screening). Poisson regression with a log link and robust error variance was used to estimate relative risks (RR) for participation. As a sensitivity analysis, data were stratified by screening round. In both the univariable and multivariable models deprivation was strongly associated with participation. Increasing affluence was associated with higher participation; participation was 26% higher in people resident in the most affluent compared to the most deprived areas (multivariable RR=1.26: 95% CI 1.21-1.30). Participation was significantly lower in males (multivariable RR=0.96: 95%CI 0.95-0.97) and generally increased with increasing age (trend per age group, multivariable RR=1.02: 95%CI, 1.01-1.02). No significant interactions between the explanatory variables were found. The effects of deprivation and sex were similar by screening round. Deprivation and male gender are independently associated with lower uptake of population-based FIT colorectal cancer screening, even in a relatively deprived setting. Development of evidence-based interventions to increase uptake in these disadvantaged groups is urgently required.
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Ireland. Electronic address: n.clarke@ncri.ie.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Clarke
authors.affiliation: Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland. Electronic address: mcnamad@tcd.ie.
authors.forename: Deirdre
authors.initials: D
authors.lastname: McNamara
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Ireland. Electronic address: patricia.kearney@ucc.ie.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kearney
authors.affiliation: Faculty of Health Science, Trinity College Dublin, Dublin, Ireland. Electronic address: omorainc@tcd.ie.
authors.forename: Colm A
authors.initials: CA
authors.lastname: O'Morain
authors.affiliation: Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland. Electronic address: nikkialexandree@gmail.com.
authors.forename: Nikki
authors.initials: N
authors.lastname: Shearer
authors.affiliation: Institute of Health & Society, Newcastle University, England. Electronic address: linda.sharp@ncl.ac.uk.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007494:Ireland; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D010358:Patient Participation / Q000706:statistics & numerical data*; D011203:Poverty; D012737:Sex Factors
keywords: Cancer; Colorectal; Deprivation; FIT; Faecal Immunochemical Test; Gender; Participation; Screening