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sPatient characteristics in our safety-net health system differed greatly from that of the generalpopulation. A vast majority of patients presented to PHHS after becoming symptomatic and/or being referred by an outside facility. The data suggest that most patients lacked accessto preventive care and CRC screening, and thus presented with advanced CRC at diagnosis.The data raise fundamentally important health policy issues relating to access to care andpopulation-based CRC screening.

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Screening for Colorectal Cancer in a Safety-Net Health Care System: Access toCare Is Critical and Has Implications for Screening PolicySamir Gupta, Liyue Tong, James E. Allison, Elizabeth Carter, Mark Koch, Don C. Rockey,Paula R. Anderson, Chul Ahn, Keith Argenbright, Celette S. Skinner

Background: Most safety-net health systems provide care for racial/ethnic minorities andthe uninsured which includes screening average risk patients for colorectal cancer (CRC).Data on the number of individuals eligible for screening and rates of screening in thesesystems, however, are sparse. Methods: We performed a retrospective cohort study ofindividuals aged 50-85 served at our safety-net hospital in 2006 to determine: 1) Size ofpotential screen-eligible population aged 50-85, 2) Rate of screening over 5 years amongindividuals aged 54-85 in 2006, 3) Potential predictors of successful screening, includingsex, race/ethnicity, insurance status, frequency of outpatient visits, and socioeconomic status.Participation in screening was determined by searching administrative databases for a) fecaloccult blood testing in 2005 or 2006, or b) any barium enema, any flexible sigmoidoscopy,or any colonoscopy 2002-2006. Results: 30,301 individuals were screen eligible; medianage 58 years, 58% were women, 44%, 29%, and 23% were White, African American, andHispanic, respectively. 24% had no insurance, while 40% had only temporary county-healthsystem insurance. Of 30,301 potential screen-eligible individuals, 22,009 were aged 54-85and analyzed for screening; 24% were screened within the preceding 5 years. Fecal occultblood testing accounted for the largest proportion of screening. Table 1 highlights significantindependent predictors of screening. Access to care was an important factor: adjusted(aj)OR 2.6 (95%CI 2.3-3.0) for any insurance, ajOR 3.5 (95%CI 3.2-4.0) for ≥2 outpatientvisits in 2006. Conclusions: The screen-eligible population served by our safety-net healthsystem was large, and the projected deficit in screen rates was substantial. Access to carewas the dominant predictor of screening participation. Strong advocacy for more resourcesfor CRC screening interventions (including research into the best manner to provide screeningto large populations) is needed.Table 1. Significant predictors of CRC screening in a safety-net health system

†Any insurance is defined by Medicaid, Medicare, private insurance, or other insurance.JPS, Tarrant County Hospital District John Peter Smith Hospital Health Network.

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Type of Medical Insurance Is Associated with Decreased Compliance withColonoscopyMaria C. Hatara, Jayme Tishon, Marie L. Borum

INTRODUCTION Colorectal cancer causes significant morbidity and mortality in the UnitedStates. African-Americans are disproportionately affected by this malignancy. Studies revealthat African-Americans have lower screening rates than other ethnic groups. Multiple factors,including insurance status, have been reported to affect the colorectal cancer screening rate.It has been suggested that additional payments for colonoscopy associated with variousinsurances affect compliance with screening recommendations. This study evaluated thepotential relationship between colonoscopy compliance and insurance status. METHODS Aretrospective medical record review of consecutive patients referred for colonoscopy duringa 6-month period was performed. There were no exclusion criteria. Patient gender, raceand insurance type were obtained. A database was created using Microsoft Excel. Identifyingfactors were eliminated to ensure patient confidentiality. Chi-square and relative risk ratioswere performed. The study was approved by the institutional review board. RESULTS Themedical records of 985 patients (577 women, 408 men) referred for colonoscopy werereviewed. There were 249 (25%) white, 407 (41%) African-American, 37 (4%) Hispanicand 15 (2%) Asian patients. Two hundred seventy-five (28%) patients were of unknownrace / ethnicity. All of the patients were insured. Three hundred one (30.5%) patients hadthe recommended colonoscopy. There was no significant difference in the rate at whichpatients complied with colonoscopy based upon gender or race. Patients with Medicaidwere less likely to comply with recommended colonoscopy (RR=0.61; 95% CI=0.44-0.84)when compared to patients with other types of insurance. Review of insurance requirementsrevealed that the patients who were referred for colonoscopy and were insured by Medicaid

A-334AGA Abstracts

had no additional payment associated with the procedure. CONCLUSION This study revealedthat decreased compliance with colonoscopy was associated with Medicaid insurance. How-ever, the suggestion that the additional payment associated the performance of colonoscopieswas the reason for noncompliance may not be correct. It appears that Medicaid is representat-ive of other factors that influence compliance. Further work is necessary to aid in identifyingthe actual factors that decrease compliance with colonoscopies. It is critical that efforts aremade to improve the rate of colorectal cancer screening.

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Increasing Delay Between Patient Presentation and Treatment for ColorectalCancer: A Population-Based StudyHarminder Singh, Carolyn DeCoster, Emma Shu, Katherine Fradette, Steven Latosinsky,Marshall W. Pitz, Mary S. Cheang, Donna Turner

The recent focus on wait times for cancer care in Canada has been on time to treatmentafter diagnosis of cancer (treatment wait time). For diagnostic delays, the focus has beenon wait time for radiological tests, as they are the essential modality necessary for thediagnosis of most cancers. The diagnostic work-up for colorectal cancer (CRC) differs fromother cancers in that most CRCs are diagnosed by lower gastrointestinal (GI) endoscopy.No prior population-based study has evaluated the wait times from patient presentation totreatment (overall health system wait time (OWT)) for CRC in Canada. Methods: Patientswith colorectal adenocarcinomas diagnosed between 2001 and 2005 and their first definitivetreatments were identified from the population-based Manitoba Cancer Registry. By linkageto Manitoba Health's administrative databases (medical claims and hospital discharges data-bases), we determined the first GI investigation (abdominal radiological imaging, lowergastrointestinal endoscopy or FOBT) in the year prior to the CRC diagnosis. The indexcontact with the health care system for GI a symptom was estimated by the date of the visitwith the physician who ordered the first GI investigation. The OWT was estimated as thetime between the index contact and the first treatment. Analysis of diagnostic delay wasbased on the time between the index health care system contact and the ultimate diagnosisof cancer. Time trends in wait times were evaluated. Multivariate Cox regression analysiswas performed to adjust for effect of age, gender, urban vs. rural residence, socio-economicstatus, place of diagnosis, colon vs. rectal site of cancer, Charlson co-morbidity score, typeof initial test and ER presentation prior to CRC diagnosis. Results: The OWT was estimatedfor 2,552 cases. The median OWT increased from 61 days in 2001 to 95 days in 2005 and75th percentile from 116 days in 2001 to 179 days in 2005 (p<0.001 for trends). Most ofthe increase was in diagnostic wait times (median of 44 days in 2001 increased to 64 daysin 2005; 75th percentile of 92 days in 2001 increased to 141 days in 2005; p<0.001 fortrends). In multivariate analysis, the year of diagnosis remained a significant predictor ofOWT. Conclusions: Overall health system wait times for treatment of CRC in Manitoba areincreasing. This is especially concerning given the advent of population-based CRC screeningin the province, which will place additional demands on the limited diagnostic capacity.Further work is required to determine whether this magnitude of increase in wait times hasany impact on patient outcomes.

M1028

Colorectal Cancer and the Elderly: Prevalence and Clinical Significance ofGeriatric SyndromesNeena S. Abraham, Aanand D. Naik, Mark Kunik, Peter Richardson

Background: As the population ages, the number of older patients diagnosed with colorectalcancer (CRC) will increase. Common geriatric syndromes have implications for subsequentmorbidity and mortality but gastroenterologists often overlook them when caring for olderpatients. Our aim was to assess the prevalence of geriatric syndromes and their effect onmortality in a population-based sample of older CRC patients. Methods: We undertook across-sectional study using the national inpatient, outpatient and death files of the Departmentof Veterans Affairs to identify veterans > 60 years with a new diagnosis of CRC (ICD-9-CMcodes 153.0-153.4 and 153.6-154.1) from 10/1/03-10/01/08. To ensure an incident cohortof non-metastatic disease, we excluded patients with a CRC code in the 5 years prior to theperiod of observation and those with ICD-9 codes for spread of tumor beyond regionallymphatics. The geriatric syndromes of dementia, depression, delirium, falls/injury, balancedisorder, incontinence and pressure ulcers were assessed using previously published dia-gnostic algorithms. Cox Proportional Hazards models (adjusted for age, race, gender andDeyo co-morbidity) examined the effect of geriatric syndromes on all-cause mortality within3 years of incident diagnosis. Results: Among 60,265 older adults (mean age, 74.5 [SD7.8], 98.4% male, 66.4% Caucasian), the overall prevalence of geriatric syndromes was low(25%). However, the presence of a geriatric syndrome was strongly associated with mortalityin all adjusted models. The greatest risk for mortality was among patients with pressureulcers (HR 2.6; 95% CI: 2.1-3.1), dementia (HR 1.7; 95% CI 1.5-1.9) and delirium (HR1.5; 95% CI: 1.3-1.9). Older adults suffering from incontinence and falls were 34% and48% more likely to die within 3 years of diagnosis. Furthermore, as the older adult accumu-lated geriatric syndromes, the risk of subsequent death markedly increased. Conclusions:Geriatric syndromes are common among elderly CRC patients, and their presence is stronglyassociated with death. Gastroenterologists should assess the presence of geriatric syndromesand consider their effect on health and disability when planning curative, palliative andsurveillance management strategies for older adults.

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Race and Screening Colonoscopy in the VA SystemDeborah A. Fisher, John Castor, Janet Grubber, Cynthia J. Coffman

Objectives: Mortality for minority patients, particularly African-Americans, with colorectalcancer (CRC) is higher than for Caucasian patients with CRC. This racial disparity isattenuated in the VA system, but not eliminated. The reasons for this mortality differenceare unknown, but in the VA, do not appear related to differences in cancer care. Differences