S317 Demographic Disparities in Colorectal Carcinoma Screening in a Large Urban Federally Qualified Health Center Network

Abstract

Introduction: Epidemiologic studies continue to show disparities in CRC screening. Demographic factors including age, gender, race/ethnicity, level of education, and primary language affect the chance of having age-appropriate CRC screening. The endpoint of this study was to investigate potential differences in CRC screening by gender, race/ethnicity, and primary language in one of the largest Federally Qualified Health Center (FQHC) networks in the U.S. Methods: In this retrospective, observational study, data was obtained from the electronic medical records (EMR) of 12,663 patients aged 50-75 years old seen at Family Health Centers at NYU Langone during the period between August 2019 and July 2020. Results: CRC screening was done in n=4034 (56.6%) females, but only n=2531 (45.7%) males. In terms of race/ethnicity, CRC screening was done in n=4002 (58.9%) in Hispanics, n=723 (63.7%) Non-Hispanic Asians, n= 1341 (40.5%) Non-Hispanic African/Americans and n= 468 (34.4%) Non-Hispanic-Whites. In terms of language, CRC screening was done in n= 2842 (42.4%) English-speaking patients, n= 3071 (62%) Spanish-speaking patients and n= 575 (66.8%) Chinese-speaking patients. Conclusion: Age-appropriate CRC screening rates differed by gender, race/ethnicity, and primary language. The lower age-appropriate CRC screening rate in males is consistent with what we know about CRC screening trends in the U.S. Surprisingly, the age-appropriate CRC screening rate was higher in Non-Hispanic Asians and Hispanics, and in those who speak a language other than English. Additionally, the age-appropriate CRC screening rate was higher in non-Hispanic African Americans than in Non-Hispanic-Whites. (Table). Improvement in CRC screening in Hispanics, Non-Hispanic Asians, and non-Hispanic African Americans has likely been due to EMR best practice and care gap flags which prompt providers to screen patients. Within the immigrant population, both literacy and culture have been shown to have a strong impact on health care utilization. Diminishing disparities in screening further may require increasing patient education that is culturally sensitive and accessible for patients with low health literacy. Table 1. - Characteristics of patients, stratified by CRC screening status Patients with one or more screenings for colorectal cancer P Yes No Variable Overall (n=12,663), n (%) (n= 6565), n (%) (n= 6098), n (%) Sex at birth Male 5537 (43.7) 2531 (45.7) 3006 (54.3) < 0.01 Female 7126 (56.3) 4034 (56.6) 3092 (43.4) Race/Ethnicity Non-Hispanic - White 1359 (10.7) 468 (34.4) 891(65.5) < 0.01 Hispanic (All races) 6793 (53.6) 4002 (58.9) 2791 (41.1) Non-Hispanic African/American 3310 (26.1) 1341 (40.5) 1969 (59.5) Non-Hispanic Asian 1135 (9) 723 (63.7) 412 (36.3) Other 66 (0.52) 31(47) 35 (53) Primary Language English 6700 (52.9) 2842 (42.4) 3858 (57.6) < 0.05 Spanish 4950 (39.1) 3071 (62) 1879 (38) Chinese 861 (6.8) 575 (66.8) 286 (33.2) Other/Unreported 152 (1.2) 1 (0.6) 151. 151.(99.4)