Lack of Health Equity in Rural Missouri's Bollinger County Led to Delayed Diagnosis and Higher Adverse Outcomes for Inflammatory Bowel Disease Patients and Reduced Colorectal Cancer Screening Rates

Background:
Disparities exist in healthcare despite great advancements. Health equity is essential in our society, but it is severely lacking currently. It is well known that early diagnosis and treatment of inflammatory bowel disease (IBD) improves outcomes for the patients. Due to this knowledge, I decided to study and compare IBD diagnosis delays, and adverse outcomes in my rural county. In addition, I studied a broader topic of colorectal cancer (CRC) screening in my region in the same context, of which IBD was a subgroup. CRC is the third leading cause of cancer death in USA. 70% of the eligible USA population is screened for CRC. With this information, I decided to study and compare CRC screening rate in my rural county.
Methods:
1000 people in 2 adjacent rural counties (500 in Cape Girardeau and 500 in Bollinger) in Missouri were surveyed. People accessing primary healthcare between the ages of 45-75 years, meeting CRC screening eligibility were surveyed. Additional health and demographic information were acquired from participants. P values were calculated to determine the statistical significance.
Results:
In Cape Girardeau County 22 IBD cases were identified and in Bolliger county 20 IBD cases were identified. 90% of the cases in Cape Girardeau County were diagnosed in less than 1 year of symptom onset, whereas 40% of cases in Bollinger County were diagnosed within less than 1 year of symptom onset (p=0.00001, statistically significant). 14% of the cases in Cape Girardeau County required surgery and 45% of the cases in Bollinger County required surgery (p=0.02444, statistically significant). In Cape Girardeau County, the cumulative CRC screening rate was 65%, slightly below the national average of 70% (p=0.9102, not statistically significant). In Bollinger County, the cumulative screening rate was 51%, well below the national average (p=0.00001, statistically significant) and well below Cape Girardeau County (p=0.00001, statistically significant). Colonoscopy was the leading method of screening in this area. 100% of the screenings were prompted or initiated by the primary care physicians.
Conclusions:
Despite sharing boundaries, being in the same geographic region, and the county headquarters existing a mere 35 miles apart. The 2 rural counties have significant disparities in IBD diagnosis delay, IBD adverse outcome requiring surgery, and CRC screening rates. Conditions to account for are that 2 large health systems exist in Cape Girardeau County in addition to many satellite offices. No major health systems or gastroenterologists are present in Bollinger County. Lower average income and lower health insurance enrollment are likely another driving factor of this disparity. To establish health equity, it will require a health system to create facilities in Bollinger County. Alternate options can also be a video-based platform to connect patients with gastroenterologists at nearby medical school teaching hospitals to which they can easily commute for procedural care.