Colorectal cancer screening among individuals with a substance use disorder: a retrospective cohort study

Introduction There is limited evidence on colorectal cancer (CRC) screening among individuals with a substance use disorder (SUD). This study aims to investigate the association between personal history of a SUD and CRC colonoscopy screening completion rates. Methods This retrospective cohort study analyzed 176,300 patients of whom 171,973 had no SUD and 4,327 had an SUD diagnosis from EHR data (1/1/08-12/31/22) in a midwestern healthcare system. Baseline was 1/1/2013 and a 10-year follow-up period ran through 12/31/22. The outcome was receipt of colonoscopy in the 10-year follow-up period. Patients were 50-65 years of age at baseline, meaning they were eligible for a colonoscopy through the entirety of the 10-year follow-up period. Covariates included demographics (age, race, and neighborhood socioeconomic status), health services utilization, psychiatric and physical comorbidities, and prior colonoscopy or fecal occult blood testing. Entropy balancing was used to control for confounding in weighted log-binomial models calculating relative risk and 95% confidence intervals. Results Patients were, on average, 57.1 (±4.5), 58.2% were female, 81.0% were White and 16.9% were Black race. The most prevalent comorbidities were obesity (29.6%) and hypertension (29.4%), followed by smoking/nicotine dependence (21.0%). The most prevalent psychiatric comorbidity was depression (6.4%), followed by anxiety disorder (4.5%). During the 10-year follow-up period, 40.3% of eligible patients completed a CRC colonoscopy screening test, and individuals with an SUD diagnosis were significantly less likely to receive a CRC colonoscopy screening test both prior to and after controlling for confounding (RR=0.73; 95%CI:0.70-0.77 and RR=0.81; 95%CI:0.74-0.89, respectively). Results were not modified by gender, race, psychiatric comorbidity, or neighborhood SES. Conclusions Personal history of an SUD was independently associated with lower screening completion rates. Healthcare professionals should recognize unique barriers among individuals with an SUD and then address them individually as a multidisciplinary team in the outpatient setting to reduce this health disparity.