Research Article
The Role of Social Determinants of Health in Missed Colorectal Cancer Prevention Among Patients with Inflammatory Bowel Disease from a Safety-Net Hospital
1Division of Digestive and Liver Diseases, UT Southwestern, Dallas, TX 75390, USA
2Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL 38217, USA
3Education Service, Orlando VA Healthcare System, Orlando, FL 38217, USA
Received Date: December 2, 2025; Published Date: January 09, 2026
Abstract
Aim: Inflammatory bowel disease (IBD) increases the risk of colorectal cancer (CRC). This study aimed to assess the social determinants of
health (SDH) and the burden of CRC among IBD patients within a large urban safety-net health system and to identify potential missed opportunities
for CRC prevention.
Methods: We performed a retrospective review of electronic medical records for patients aged 18 and older treated at an urban safety-net
health system from January 2010 to February 2024. Patients were included if they: 1) had diagnoses of both IBD and CRC, identified using ICD codes;
and 2) had undergone at least one colonoscopy during the study period. We evaluated SDH, healthcare utilization, IBD and CRC characteristics.
Results: Fifteen patients met the inclusion criteria (9 with ulcerative colitis). Demographic characteristics included: 66.7% male and 60%
white. Seven patients (46.7%) received healthcare services through county-hospital financial assistance. Majority of patients had transportation
barriers (67%). Sixty percent had not seen a primary care provider or gastroenterologist within the past year before CRC diagnosis. Financial
barriers (38.5%) were a documented cause of therapy interruption or delayed follow-up. There were 9 (60%) deceased patients; overall survival
ranged from 1 to 137 months (median: 9 months).
Conclusion: Transportation barriers, unemployment and low household median income were the predominant SDH among IBD patients who
developed CRC. Gastroenterology follow-up, use of advanced therapeutics, and timely disease activity monitoring were infrequent in this cohort.
Financial barriers and resource limitations contributed substantially to the care burden for low-income patients.
Keywords:Inflammatory Bowel disease; Colorectal cancer; Social determinants of health
Abbreviations and Acronyms:IBD: Inflammatory bowel disease; CC: Colorectal cancer; SDH; Social determinants of health; CD: Crohn’s disease; UC: Ulcerative colitis; PSC: Primary sclerosing cholangitis; CAC: Inflammatory bowel disease associated colon cancer; sCRC: Sporadic colorectal cancer
