Background In Illinois for the year 2015, colorectal cancer (CRC) is projected to cause 2,090 deaths, making it the leading cause of non-tobacco related cancer mortality. African American or black Illinois residents have an approximately 7% greater incidence and a 30% higher mortality rate when compared to white residents. Guideline consistent CRC screening is known to increase early diagnosis and reduce cancer related death. Colonoscopy is the most commonly performed screening modality and diagnostic colonoscopy is required for follow up of abnormal non-invasive screening tests.
The City of Chicago is home to 2.7 million residents, of whom 31% are non-Hispanic white and 37% are non-Hispanic black. Chicago is known to have significant residential racial segregation with 69% of the total non-Hispanic black population living within communities located south of Roosevelt Avenue, on Chicago's south side. Relatively homogenous minority communities, such as Chicago's south side, are prone to the development of healthcare inequities that may result in the development of healthcare disparities.
Objective The objective of this study was to use geographic information systems and geospatial analysis to investigate the spatial distribution of healthcare facilities that perform colonoscopy within the City of Chicago.
Methods Population demographic data by census block was obtained from the U.S. Census Bureau, 2009–2013 American Community Survey 5-Year Estimates. The locations of facilities performing colonoscopy procedures were identified through internet search; review of Illinois Department of Public Health hospital listings; and ambulatory surgery center (ASC) accreditation listings. Each facility was contacted by phone to confirm performance of on-site colonoscopy and to obtain the number of on-site endoscopy procedure rooms. The addresses of facilities were geocoded using GPS Visualizer. City of Chicago census tract boundaries were mapped using U.S. Census Bureau Tiger Line shapefiles. Maps were created and geospatial analysis was performed using Esri ArcMap version 10.2.
Results Within the City of Chicago, a total of 41 facilities were identified that perform on-site colonoscopy. Of the 41 facilities, 26 were hospital-based and 15 were ASC-based. 10 of 26 (38%) Hospital-based colonoscopy sites and 3 of 15 (20%) ASC-based colonoscopy sites were located on Chicago's south side. There were a total of 134 endoscopy procedure rooms reported across the 41 facilities. 30 of the 134 (22%) endoscopy procedure rooms were located on Chicago's south side. Spatial overlap was observed between areas with clustering of endoscopy procedure rooms and census tracts with greater than 80% non-Hispanic white race.
Conclusions There is an unequal distribution of colonoscopy facilities and endoscopy procedure rooms across the City of Chicago with geographic clustering of colonoscopy infrastructure observed on Chicago's north side within census tracts comprised of greater than 80% non-Hispanic white race. Census tracts containing high proportions of non-Hispanic black race were clustered on Chicago's south side within areas with a relative paucity of colonoscopy infrastructure. The spatial clustering of colonoscopy procedure rooms represents a healthcare resource inequity that may contribute to the persistence of disparities in CRC related mortality among non-Hispanic black communities in Chicago.
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