Causes of suboptimal colorectal cancer screening (CRCS) in U.S. immigrants.

Abstract

380 Background: Research shows that CRCS in U.S. immigrants is low, but causes for this poor uptake are unclear. Our aims were to 1) compare CRCS among U.S. born citizens (USB), naturalized citizens (NAC) and non-citizens (NOC), 2) evaluate clinical factors associated with CRCS, and 3) explore health system barriers to CRCS for immigrants. Methods: Screening eligible patients were identified from the 2007 California Health Interview Survey. CRCS was defined as a fecal occult blood test within 1 year, a sigmoidoscopy within 5 years or a colonoscopy within 10 years. Using logistic regression, we determined the effect of immigrant status and other clinical factors on CRCS. We devised a 3-point composite scoring system based on survey responses to questions about health system barriers (where 0=worst and 3=best). Stratified analyses based on residence (urban vs rural), healthcare coverage (insured vs uninsured), English proficiency (good vs. poor), and composite score were conducted to assess their relationship with CRCS. Results: We identified 30,434 respondents: USB 83%, NAC 13%, NOC 4%; mean age 66, 65, 61 years; male 39%, 41%, 48%; white 85%, 38%, 29%, respectively. Only 67% of USB, 61% of NAC and 46% of NOC underwent CRCS (p<0.001). Old age, male, high income earners, non-smokers, being married and those who visited their physicians frequently were more likely to receive CRCS (all p<0.05). When compared to USB, NAC and NOC were associated with decreased odds of CRCS (OR 0.88, 95%CI 0.73-1.05 and OR 0.67, 95%CI 0.52-0.87, respectively; global p=0.009). Stratified analyses revealed that the association between immigrants and decreased CRCS was more evident for immigrants who lived in rural areas, lacked insurance, or those who were not proficient in English (Table). Immigrants with a composite score ≤2 also reported worse CRCS. Conclusions: CRCS remains suboptimal, especially in new U.S. immigrants. Inferior healthcare access and language barriers are potential drivers of this disparity. Addressing these system issues for immigrants may promote CRCS in this population. [Table: see text] No significant financial relationships to disclose.