S367 Neighborhood Socioeconomic Disadvantage (Area Deprivation Index) and Genetic Counseling Attendance in Patients Referred for Genetic Testing for Colorectal Adenomatous Oligopolyposis: A Real-World Retrospective Study

Introduction: Clinical guidelines advocate for genetic counseling in patients with 10 or more colorectal adenomas. However, disparities in access may limit testing uptake and delay the diagnosis of hereditary syndromes. The Area Deprivation Index (ADI), a validated measure of neighborhood-level socioeconomic disadvantage, includes factors such as income, education, employment, and housing. This study aims to assess the impact of ADI on the likelihood of completing genetic counseling in this population. Methods: We conducted a retrospective chart review of adults diagnosed with 10–99 cumulative colorectal adenomas, without a family history suggestive of hereditary colorectal cancer syndromes, at the Cleveland Clinic between March 2009 and December 2023. ADI was categorized into tertiles (low, moderate, high deprivation) using national percentiles. The primary outcome was completion of a genetic counseling encounter among those referred. Univariable and multivariable logistic regression were used to assess associations between ADI, demographic, and clinical factors and counseling completion. Results: A total of 118 patients with 10–99 colorectal adenomas were referred for genetic counseling; 66 (59%) attended their appointments. Attendance rates by ADI tertile were 63.3% in the low, 70% in the moderate, and 45.2% in the high deprivation groups. Patients from high ADI areas were older at diagnosis compared to those from low/moderate ADI areas (median age 65 vs 60 years; P = 0.027). No other factors were statistically significant. In both univariable and multivariable logistic regression, high ADI was associated with lower odds of attending a genetic appointment compared to low/moderate ADI (unadjusted odds ratio [OR] 0.31, P = 0.005; adjusted OR 0.34, P = 0.01). Other variables, including age at diagnosis, race, sex, and cumulative adenoma count, were not significantly associated with attendance in either model. Conclusion: In our cohort of patients referred for genetic counseling for adenomatous oligopolyposis, ADI was the only factor independently associated with lower attendance at genetic counseling visits, highlighting it as a key barrier to follow-up after referral and underscoring the need to explore additional individual- and system-level factors that may impact access to genetic services.