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Higher income people more likely to receive colorectal cancer tests


A new study from the Institute for Clinical Evaluative Sciences (ICES) shows that as your income goes up, so does your chance of receiving a test that can check for colorectal cancer (CRC).

Researchers identified over 1.6 million Ontarians who were 50 to 70 years old on Jan. 1, 1997 and did not have a history of CRC, inflammatory bowel disease, or screening for CRC in the previous 5 years. These individuals were followed to Dec. 31, 2001 to evaluate the association between income and receipt of any method of CRC investigation (i.e. FOBT, barium-enema radiography, sigmoidoscopy, and colonoscopy). A separate analysis specifically examined income and receipt of colonoscopy.

During the study period, only 21% of the study group received any sort of colorectal investigation. However, people with higher incomes were not only more likely to be among those who received colorectal investigation, but were also one and a half times more likely to have had a colonoscopy.

“This study shows once again that, despite universal healthcare, Canadians of higher socioeconomic status still have greater access to certain medical procedures than Canadians of lower SES,” said senior author and ICES senior scientist Dr. Linda Rabeneck.

“As such, universal health insurance alone may not reduce SES differences in CRC screening and organized screening programs should be instituted immediately to reduce this disparity.”

Dr. Rabeneck also points to the need for more research to determine why the difference among income groups exists and explore its effects on CRC mortality.

The study, “Association of socioeconomic status and receipt of colorectal investigations: a population-based retrospective cohort study”, is in the August 31, 2004 issue of the Canadian Medical Association Journal (CMAJ).

Author affiliations: ICES (Drs. Paszat, Vinden, and Rabeneck, Ms. Li and Mr. He); Department of Medicine (Drs. Singh and Rabeneck) and Department of Radiation Oncology and Health Policy, Management and Evaluation (Dr. Paszat), University of Toronto; Department of Surgery, University of Western Ontario (Dr. Vinden)

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.


  • Julie Argles
  • Media Relations Officer, ICES
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