Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence.

Kiara N Mayhand,Elizabeth A Handorf,Angel G Ortiz,Nestor Esnaola,Susan Fisher,Kristen A Sorice,Evelyn T Gonzalez,Shannon M Lynch,Amie Devlin

doi:10.3390/ijerph18094398

Abstract

Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85; 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence.

Highlights

Despite being largely preventable through screening assessments and having a 90%survival rate with early detection [1], colorectal cancer is the third leading cause of cancerrelated deaths for both men and women in the United States (US) [2]
This seemed surprising based on univariate results; our findings are consistent with previous population-based studies in Philadelphia, which report significantly higher colorectal cancer screening rates for NHB participants compared to Non-Hispanic White (NHW) and Hispanic participants in models that include adjustments for age and sex [56]
After a systematic and rigorous methodologic assessment, we identified that homeownership, perceived quality of medical care, utilization of routine doctor’s visits, perceived discrimination, and neighborhood SES circumstances (nSES) factors were associated with colorectal cancer screening adherence

Summary

Introduction

Survival rate with early detection [1], colorectal cancer is the third leading cause of cancerrelated deaths for both men and women in the United States (US) [2]. Colorectal cancer occurs when polyps, or abnormal growths, form in the colon or rectum. 2013–2017 national statistics, the age-adjusted mortality rate of colorectal cancer in the US is. Racial disparities with colorectal cancer mortality exist [3]. Black (NHB) men (23.2 per 100,000) and women (15.2 per 100,000) experience the highest colorectal cancer mortality rates compared to all other races/ethnicities [4]. Trends are similar in New Jersey (NJ) and Philadelphia, Pennsylvania (PA), the geographical focus of this study. The colorectal cancer mortality rates for NJ and Philadelphia are 14 and 17 per

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