Disparities in Up-to-date Adherence to Colorectal Cancer Screening Modalities and Their Associated Factors: Insights from the Behavioral Risk Factor Surveillance System (BRFSS) 2022-2023.

INTRODUCTION

Colorectal cancer (CRC) remains one of the leading causes of cancer-related morbidity and mortality in the United States. Despite the wide availability of effective screening tools, adherence to screening modalities and recommendations remains a significant challenge, influenced by various sociodemographic factors. This study examines the disparities and factors related to adherence to CRC screening methods.

METHODS

Participants aged 45 to 75 years were selected from the 2022-2023 BRFSS dataset. The key variables extracted included CRC screening modalities and test frequencies (colonoscopy, sigmoidoscopy, stool testing, and virtual colonoscopy), as well as sociodemographic characteristics. Multivariate logistic regression was performed to explore associations between social factors and up-to-date adherence to specific screening tests.

RESULTS

A total of 239,512,188 (Weighted frequency) adults were included in this study, with the majority identifying as White (63.90%), female (51.92%), having access to a primary care provider (PCP; 90.64%), married (61.36%), reporting a yearly income of $50,000 or greater (69.17%), and residing in urban areas (93.11%). The most reportedly used screening options were colonoscopy (27.34%) and stool-based tests (8.67%). Up-to-date adherence to colonoscopy was more likely among adults who are Black non-Hispanic (aOR = 1.86, 95% CI [1.57-2.19], p < .0001), had access to PCPs (aOR = 2.13, 95% CI [1.80-2.52], p < .0001), and urban residents (aOR = 1.18, 95%CI [1.04-1.34], p = 0.0105) among cohorts with colonoscopy. Up-to-date adherence to stool test was more likely among Hispanic (aOR = 1.37, 95%CI [1.03-1.81], p = 0.0296), those with access to a PCP (aOR 1.63, 95%CI [1.21-2.21], p = 0.0014), individuals who were divorced (aOR = 1.15, 95%CI [1.00-1.32], p = 0.0431), and uneducated ( aOR = 1.58, 95%CI [1.15-2.16], p = 0.0046) among cohorts with stool test.

CONCLUSION

Racial/ethnic background, socioeconomic status, and marital status were associated with whether individuals adhered to a particular screening modality among their cohorts with the same screening test. We recommend creating specific and culturally aware programs to overcome obstacles and targeted interventions among patients, which may help improve adherence rates.