D0164 - Representation of Racial Minorities in the United States Colonoscopy Surveillance Interval Guidelines

Jeffrey Dong, MD¹, Lauren Burdine, MD¹, Shaharyar Zuberi, MD², Joseph D. Feuerstein, MD^3
1Beth Israel Deaconess Medical Center, Boston, MA; ²Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ³Beth Israel Deaconess Medical Center (BIDMC), Boston, MA

Introduction: Clinical guidelines should ideally be formulated from data representative of the population they are applicable to. However, historically many studies have had disproportionately high rates of white patient enrollment, which could lead to inequities in care for racial minorities. In this study, we examined the degree to which racial minorities were represented in the US colonoscopy surveillance guidelines.

Methods: We reviewed US guidelines between 1997 and 2020 and identified all studies cited by recommendations for surveillance after a baseline colonoscopy with no polyps, adenomas, sessile serrated polyps (SSPs), and hyperplastic polyps (HPs). Each study within a meta-analysis was analyzed separately. We compared the proportion of studies reporting race to the proportion which reported sex and family history of colorectal cancer (CRC). Among studies reporting race, we calculated both the median percentage of minorities and the aggregate racial distribution of patients. Statistical testing was performed via Fisher’s exact test, and Bonferroni correction was applied for multiple comparisons.

Results: We reviewed a total of 77 studies, of which 35 were from the US (Table 1). 18 studies (23%) reported race, compared to 73 studies (95%) which reported sex and 34 (44%) which reported family history of CRC (p < 0.001 and p = 0.006 respectively). All studies which reported race were US-based studies, thus 51% of US-based studies reported race. Among studies that reported race, the median number of minorities was 15% of the study population, ranging from a low of 12% for studies on adenomas and HPs to 30% for studies on SSPs. In aggregate, non-white patients comprised 43% of the study population for normal colonoscopies but only 9% for adenomas, 22% of for SSPs, and 15% for HPs (p < 0.001 for all pairwise comparisons).

Discussion: Most studies on colonoscopy surveillance intervals, including approximately half of US-based studies, do not report the race of study participants. Among the studies that report racial data, minority patients are underrepresented in studies of adenoma, SSP, and HP surveillance intervals compared to the US population. Underrepresentation may lead to differences in outcomes being missed, thus future research should strive to include more data from these underrepresented groups.



Disclosures:


Jeffrey Dong, MD¹, Lauren Burdine, MD¹, Shaharyar Zuberi, MD², Joseph D. Feuerstein, MD³. D0164 - Representation of Racial Minorities in the United States Colonoscopy Surveillance Interval Guidelines, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.