The association between immigration status and ineligible stool samples for colorectal cancer screening

Background: Barriers such as language and literacy might complicate the participation procedure for immigrants in screening programs. We investigated the delivery of a suitable stool sample for participation in the Danish colorectal cancer screening by immigration background. Methods: National administrative registers were used to link results of faecal blood screening with immigrant status, age, sex, education, income, and marital status. Univariate and multivariate logistic regression models were used to estimate the odds of submitting an ineligible sample. Results: 558,104 individuals submitted a sample during 2014 and 2015. A total of 2,164 (0.4%) samples were ineligible for faecal analysis. The lowest proportions of ineligible samples were found in the highest educational level (0.2%) and highest income level (0.2%). The highest proportion of ineligible samples was seen in non-Western immigrants (1.6%). After adjustment for age, gender, educational level, income and marital status non-Western immigrants had an increased odds ratio (OR 3.64 CI95% 2.86;4.64) of submitting an ineligible sample, compared to native Danes. Western immigrants did not have an increased odds ratio. Conclusion: Non-Western immigrants have more than three times the risk of submitting an ineligible faeces sample for colorectal cancer screening than native Danes. Translation of invitation, information leaflet, and manual into other languages or targeted information for subgroups may help decrease the risk.