Utilization of lower gastrointestinal endoscopy and fecal occult blood test in 11 European countries: evidence from the Survey of Health, Aging and Retirement in Europe (SHARE)

Background and study aims: Lower gastrointestinal endoscopy (sigmoidoscopy and colonoscopy) and the fecal occult blood test (FOBT) are thought to impact on colorectal cancer incidence and mortality. We aimed to estimate prevalences and to investigate potential determinants of utilization of these procedures in the general population across Europe. Methods: Data from the Survey of Health, Aging, and Retirement in Europe (SHARE) were used. Prevalences of lower gastrointestinal endoscopy and FOBT utilization among adults aged >= 50 years in 11 countries (Austria, Belgium, Denmark, France, Germany, Greece, Italy, The Netherlands, Spain, Sweden, and Switzerland) were estimated. Potential determinants of utilization of the tests were analyzed by multivariate logistic regression. Results: Overall, 18 139 individuals were included. The proportion of respondents reporting lower gastrointestinal endoscopy and FOBT utilization within the previous 10 years ranged from 6.1% (95% confidence interval [CI] 4.7-6.9; Greece) to 25.1% (95% CI 22.1-27.2; France) and from 4.1% (95% CI 3.2-4.9; The Netherlands) to 61.1% (95% CI 58.6-63.6; Austria), respectively. Observed sex differences were highest in France and Germany; however results were only partly statistically significant. Country, age, education, income, marital status (FOBT only), location of main residence (FOBT only), smoking history, and self-perceived health status were statistically significant predictors of test utilization. Conclusion: Prevalences of lower gastrointestinal endoscopy and FOBT utilization vary widely across European countries. They need to be considered in the interpretation of cross-national differences and time trends in colorectal cancer incidence and mortality, and in the design and evaluation of colorectal cancer screening programs.