Sociodemographic changes in the population frequency of colonoscopy following the implementation of organised bowel cancer screening: An analysis of data from Swedish registers, 2006-2015.

OBJECTIVE: To assess sociodemographic changes in the population frequency of colonoscopy (PFC; number of colonoscopies per 1000 inhabitants per year) among people aged 50-74 in relation to the implementation of a regional colorectal cancer screening programme for people aged 60-69 in the Stockholm-Gotland region (RSG) in 2008. METHOD: The PFC was estimated by year (2006-2015), pre- and post-implementation of colorectal cancer screening programme (2006-2007 vs. 2014-2015), age, sex, residential region, immigrant status and educational level. The data were obtained from Swedish patient and population registers. RESULTS: The PFC largely increased during 2006-2015 in all six Swedish regions. The estimated increase in the pre- vs. post period PFC (ΔPFC) within the RSG was (i) greater for men than for women (5.8 vs. 4.5) and (ii) smaller for people aged 70-74 than for those aged 60-69 (5.5 vs. 9.0), while the corresponding ΔPFCs within each of the other regions were (i) not greater, or even smaller, for men and (ii) not smaller, or even larger, for elderly people aged 70-74. CONCLUSION: A regional implementation of an organised colorectal cancer screening programme did not lead to a higher PFC increase in the screening relevant age group 50-74 years. Nevertheless, changes in the PFC were more pronounced for men and less pronounced for people aged 70-74 than those invited to participate in the screening programme (60-69 years), as compared with the rest of Sweden (without organised colorectal cancer screening).

Perforations and bleeding in a population-based cohort of all registered colonoscopies in Sweden from 2001 to 2013.

Background: The rates of perforation and bleeding are important quality measures of colonoscopy performance. Objective: The objective of this article is to assess the frequency of colonoscopy-related bleeding and perforation in Swedish counties and to relate these findings to patient characteristics. Method: Data on 593,308 colonoscopies performed on adults from 2001 to 2013 were retrieved from Swedish inpatient and outpatient registers. Covariates were assessed in a multivariate Poisson regression model. The correlation between perforation and bleeding was calculated with Pearson's bivariate correlation formula. Results: The relative frequency of bleeding and perforation vary across counties (bleeding: 0.02%-0.27%; perforation: 0.02%-0.27%). There were significant positive correlations between the relative frequency of bleeding and perforation at the county level, both including (r = 0.792, p < 0.001) and excluding polypectomies r = 0.814 (p < 0.001). The relative risks of these conditions in the counties ranged from 0.12, p < 0.001, to 1.53, p = 0.05 (bleeding) and from 0.17, p = 0.002, to 2.42, p < 0.001 (perforation). Conclusions: There are substantial differences in colonoscopy performance in Sweden. These differences do not seem to be explained by patient characteristics.