Demographic and Socio-Economic Trends in Colon Cancer Screening Rates Among Older Adults in the United States

Introduction: Colorectal cancer (CRC) screening decreases incidence and improves survival. Screening rates can be influenced by disparities in demographic, social and economic factors. Using a large US database, We aimed to study the demographic and socio-economic factors affecting colon cancer screening rates among older adults. Methods: We used the Behavior Risk Factor Surveillance System, a nationally representative health-related telephone survey in 2020, to compare reported colorectal cancer screening rates. We included all respondents over the age of 50 eligible for colon cancer screening. We performed binary logistic regression modeling to obtain adjusted odds ratios (aORs) adjusting for race, level of education, health care access limited by insurance coverage and cost. Weighted percentages were calculated as appropriate. Statistical analysis was performed using IBM SPSS version 25, IBM corp. Results: Of the 401,959 patients surveyed, 132,128 (72.39%) eligible patients had reported undergoing at least one of recommended CRC tests in the appropriate time interval, 43,570 (27.61%) had reported not undergoing any form of screening. Individuals with no cost issues related to access to a doctor in the past year, graduated high school, college attendance and Caucasian had a lower reported risk of lack of CRC screening (aOR 0.729, 0.699, 0.761 p< 0.001; aOR 0.829, 0.788, 0.872 p< 0.001; aOR 0.684, 0.651, 0.720, p< 0.001, aOR 0.731, 0.698, 0.765 p< 0.001 respectively). Individuals without insurance, minority races and females had a higher reported risk of lack of CRC screening (aOR 3.230, 3.082, 3.384 p< 0.001; aOR 1.459, 1.350, 1.576 p< 0.001; aOR 1.084, 1.059, 1.110 p< 0.001 respectively). (Table) Conclusion: In this large national survey, we found a modest increase in reported risk of lack of appropriate CRC screening in individuals without insurance, minority groups and females. Individuals with Caucasian race, no cost issues, high school or college education were associated with higher rates of appropriate CRC screening. Further studies on the influence of social determinants of health are required to study its effect on CRC screening rates. Table 1. - Logistic regression Modeling to obtain adjusted odds ratios (aORs) adjusting for race, level of education, health care access limited by insurance coverage and cost P value Adjusted Odds Ratio (aOR) 95% C.I. Lower Upper No cost issues < .001 .729 .699 .761 No insurance .000 3.230 3.082 3.384 Female < .001 1.084 1.059 1.110 Age 55 to 59 .000 .441 .426 .457 Age 60 to 64 .000 .370 .358 .384 Age 65 to 64 .000 .284 .273 .294 Age 65 to 69 .000 .234 .225 .244 Age 60 to 74 < .001 .260 .241 .281 Graduated high school < .001 .829 .788 .872 Attended College < .001 .684 .651 .720 Graduated College < .001 .535 .509 .563 Caucasian < .001 .731 .698 .765 African American < .001 1.459 1.350 1.576 American Indian < .001 1.295 1.190 1.409 Asian only .006 1.253 1.068 1.470 Other Race < .001 1.138 1.056 1.225