The effects of social determinants of health on colorectal cancer screening.

Abstract

6568 Background: Colorectal cancer is the 3rd leading cause of cancer death in the United States yet has consistently lagged in screening rates compared to other cancers. While patient-reported barriers have been previously described, few studies have analyzed how patients’ social needs affect screening rates. Methods: This cross-sectional study includes 3974 Kaiser Permanente (KP) patients ages 50-75 years who completed the 2020 KP National Social Needs Survey. Survey respondents were from the seven KP regions of Southern California, Northern California, Colorado, Washington, Northwest, Georgia, and Hawaii. Five Social Needs categories were assessed: Financial Strain, Housing Instability, Transportation Issues, Social Isolation, and Food Insecurity. Being up to date on CRC screening was determined from patients’ KP electronic health records, defined as meeting HEDIS criteria for screening. Multivariate analyses compared the level of social need to the respondents’ completion of colorectal screening between the years of 2019-2021, adjusting for age, sex, race/ethnicity, diagnostic category group (DxCG), neighborhood deprivation index (NDI), and insurance type. Results: Among the 3974 survey respondents, 92.2% were up to date on their colorectal cancer screening. Not being up to date on CRC screening was significantly associated with having any social need and having severe needs in four of the five social need domains adjusted for sociodemographic and health status (Table). Patients were less likely to be screened if they had severe financial strain (OR 0.54, 95% CI 0.40-0.73), severe social isolation (OR 0.52, 95%CI 0.38-0.71), severe transportation issues (OR 0.33, 95% CI 0.18-0.61), and severe food insecurity (OR 0.41, 95% CI 0.27-0.62). No significant association between screening status and the domain of severe housing instability were found (OR 0.74, 95% CI 0.52-1.06). Conclusions: Respondents with financial strain, social isolation, food insecurity, and transportation issues had lower odds of being up to date with colorectal cancer screening. Future efforts aimed to improve colorectal cancer screening rates should assess patients’ social needs and target ways to address these potential barriers to screening. [Table: see text]