S294 Decline in Colorectal Cancer Screening Rates in Federally Qualified Health Centers in Los Angeles County From 2019 to 2020

Abstract

Introduction: Federally Qualified Health Centers (FQHCs) are funded by the Health Resources and Services Administration (HRSA) to provide primary care services to low-income and underinsured individuals. Los Angeles County (LAC) is a large, diverse county with greater than 10.2 million residents and 8 distinct Service Planning Areas (SPAs) that represent specific geographic regions with variable resources. We aimed to describe colorectal cancer (CRC) screening rates (CRCSR) and the screening rate change (SRCs) in LAC overall and for each SPA between 2019 and 2020 to determine where resources are most needed for CRCSR recovery following the COVID-19 pandemic. Methods: Our data source was the Uniform Data System (UDS), which includes quality data for the FQHCs funded by HRSA. We determined 2019 and 2020 CRCSR for LAC FQHCs overall and for each FQHC, including average-risk patients age 50-74. We then separated FQHCs into quartiles based on SRC and performed mixed-effects logistic regression to determine FQHC-level characteristics associated with the largest decline in CRCSR from 2019 to 2020 (i.e., predictors of category SRC Q1). Lastly, we determined SRC for each SPA in LAC. Results: In 2019, there were 58 FQHCs in LAC with 326,473 patients eligible for CRC screening. In 2020, there were 59 FQHCs with 350,405 eligible patients. The median 2020 CRCSR in LAC FQHCs was 37.3%, down from 48.0% in 2019 (2020 median SRC= -9.6%) (Table). In the regression model among all LAC FQHCs, those with higher proportions of patients preferring a non-English language had significantly higher odds of having the largest decline in CRCSR from 2019 to 2020 (SRC Q1) (aOR=3.25, 95% CI=1.22-8.65; data not shown). CRCSR decreased from 2019 to 2020 in all SPAs with SRC ranging from -17.0% (South Bay) to -1.4% (West LA) (Figure). Conclusion: In Los Angeles County FQHCs, CRC screening rates were higher than the national FQHC average in 2019 however declined considerably between 2019 and 2020. The decline in CRC screening rates was highest in FQHCs serving a higher proportion of patients with a preference for a non-English language and varied by county region. Our findings highlight the need for targeted measures, including language-appropriate resources, to improve CRC screening uptake in FQHCs that provide care to some of the most historically marginalized individuals.Figure 1.: A) Median CRC screening rate among adults age 50 to 74 at FQHCs in Los Angeles County in 2019, by Service Planning Area (SPA). B) Percent change in CRC screening rate (screening rate change, SRC) for adults age 50 to 74 at FQHCs in LA County between 2019 and 2020, by SPA; n=58 FQHCs Table 1. - FQHC characteristics (2020 data) and CRC screening rates (2019 and 2020) for HRSA-funded FQHCs in LA County overall and by 2020 CRC screening rate change quartiles Frequency or percent Overall (n=59) SRC Q1 (n=15) SRC Q2+Q3+Q4 (n=44) p-value Total patients eligible for CRC screening (age 50-74) 350,405 79,218 271,187 n/a CRC screening rate in 2019 (median %) 48.0 61.4 44.7 0.0001 CRC screening rate in 2020 (median %) 37.3 37.3 37.3 0.97 Change in CRC Screening Uptake between 2020 and 2019 Median -9.58 -24.49 -5.52 < 0.0001 Interquartile Range -15.2, -2.2 -31.4, -17.2 -10.0, -1.3 Sex Male (median %) 41.5 42.2 41.4 0.83 Race & Ethnicity (median %) White Non-Hispanic 8.7 6.2 10.2 0.12 Black Non-Hispanic 6.4 4.6 6.7 0.40 Hispanic/Latine 63.5 54.9 63.7 0.94 Other Non-Hispanic 2.6 1.8 2.6 0.16 Preference for non-English Language (median %) 34.1 43.4 33.3 0.01 Urban FQHCs, n (%) 59 (100%) 15 (100%) 44 (100%) n/a Experiencing homelessness (median %) 2.3 2.4 2.2 0.57 Income Level >200% FPL (median %) 2.1 1.8 2.2 0.60 Uninsured (median %) 22.6 22.7 22.6 0.72 Medicaid (median %) 41.8 40.0 42.0 0.52 Medicare/Medicaid Dually Eligible (median %) 3.0 2.8 3.0 0.64 Private Ins (median %) 7.1 10.2 6.5 0.19 Agricultural Workers (median %) 0.26 0.30 0.26 0.74