Inequities in colonoscopy access: a retrospective audit of accepted referrals in Te Whatu Ora Counties Manukau.

Aim: Māori are more likely to have colorectal cancer (CRC) diagnosed in the emergency setting.[[1]] CRC patients diagnosed in the emergency setting have a higher stage, increased surgical complications and worse survival than those diagnosed elsewhere.[[2]] Access to colonoscopy is crucial to diagnosing CRC prior to an emergency presentation. This study aims to assess inequities in access to symptomatic and surveillance colonoscopies.

Methods: A retrospective audit of all accepted referrals for symptomatic and surveillance colonoscopies made in Te Whatu Ora Counties Manukau in 2018 (n=7,184) with analysis by multivariate logistic regression.

Results: Of the 751 Māori patients, 33.4% were removed off the waiting list and therefore did not have their colonoscopy performed, compared to 24.1% of the 4,047 NZ European patients. Māori patients were significantly more likely to be removed off the waiting list than NZ European patients with an adjusted odds ratio of 1.68 (95% confidence interval [CI] 1.40-2.02). Pasifika patients were significantly more likely to be removed off the waiting list than NZ European patients with an adjusted odds ratio of 2.30 (95% CI 1.92-2.75).

Conclusions: Māori have significantly less access to colonoscopies than NZ Europeans. We suggest improvements to referral systems locally and nationally to facilitate equitable access.