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Original article
Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide
  1. CM de Klerk1,
  2. S Gupta2,
  3. E Dekker1,
  4. ML Essink-Bot3
  5. on behalf of the Expert Working Group ‘Coalition to reduce inequities in colorectal cancer screening’ of the World Endoscopy Organization
  1. 1Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, San Diego, California, USA
  3. 3Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Professor Evelien Dekker, Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; e.dekker{at}


Objective Colorectal cancer (CRC) screening programmes can reduce CRC mortality. However, the implementation of a screening programme may create or exacerbate socioeconomic and ethnic health inequities if participation varies by subgroup. We determined which organised programmes characterise participation inequities by socioeconomic and ethnic subgroups, and assessed the variation in subgroup participation among programmes collecting group-specific data.

Design Employing a literature review and survey among leaders of national or regional screening programmes, this study identified published and unpublished data on participation by socioeconomic status and ethnicity. We assessed programmes offering faecal occult blood tests (FOBT) for screening. Primary outcome was screening participation rate.

Results Across 24 organised FOBT-screening programmes meeting the inclusion criteria, participation rates ranged from 21% to 73%. Most programmes (13/24, 54%) did not collect data on participation by socioeconomic status and ethnicity. Among the 11 programmes with data on participation by socioeconomic status, 90% (28/31 publications) reported lower participation among lower socioeconomic groups. Differences across socioeconomic gradients were moderate (66% vs 71%) to severe (35% vs 61%). Only six programmes reported participation results by ethnicity. Ethnic differences were moderate, though only limited data were available for evaluation.

Conclusions Across organised CRC screening programmes worldwide, variation in participation by socioeconomic status and ethnicity is often not assessed. However, when measured, marked disparities in participation by socioeconomic status have been observed. Limited data were available to assess inequities by ethnicity. To avoid exacerbating health inequities, screening programmes should systematically monitor participation by socioeconomic status and ethnicity, and investigate and address determinants of low participation.


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  • Essink-Bot died on May 2016.

  • Contributors All authors have contributed to this article in the following way: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. Final approval of the manuscript. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors: conception and design, data analysis and interpretation, critical revision of the manuscript, supervision; CMdK and MLE-B: data acquisition; CMdK: drafting the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement On request, we are willing to consider data sharing.