Disparities In Screening Research Articles

Abstract 4115235: Disparities in Youth Cardiac Screening by Childhood Opportunity Index: Insights from the Heartbytes Database

Intro: The AHA endorses screening youth athletes to identify risk for sudden cardiac arrest (SCA). Rates of SCA can be predicted by social determinants of health (SDOH) such as education level and proportion of Black residents in ZIP Code. The Child Opportunity Index (COI) quantifies neighborhood factors that influence health and development. The link between COI and youth cardiac screening findings and outcomes remains unclear. Hypothesis: Cardiac screening data will differ significantly by COI. Aims: To identify differences in cardiac screening data in children of varying COI. Methods: The HeartBytes Database, including sports exams, self-reported physical activity (PA), and zip codes from Simon's Heart screenings was augmented with COI index zip code data. Chi-squared and logistic regression were used to analyze demographics, cardiac risk factors, and screening results. Data: Screening data of 11,431 youth athletes (median age 14.3 (IQR = 3), BMI 20.6 (4.8), 53.7% male, 70.6% White) was analyzed. The majority of children had very high overall COI (Figure 1). Hypertension, hyperlipidemia, Kawasaki disease, and heart infection were similar across COI levels (p > 0.05). Levels of physical activity varied significantly across levels of overall COI, with the highest levels reported in the lowest COI group (50.4% with > 10 hours PA/week) (Chi-Squared; p = 0.007). Positive screening rates varied significantly by level of COI (p = 0.013) (Figure 2). The overall level of education, health environment, and socioeconomic COI did not predict positive screening outcomes in logistic regression analysis (all p>0.05). Conclusion: Prevalence of cardiac risk factors did not vary significantly across COI levels, however, positive screening rates were highest in moderate and very low COI levels. Simon’s Heart engaged communities across the COI spectrum; however, a majority of children had high or very high COI. Further efforts are needed to expand access to underserved populations of lower COI.

Rural-Urban Disparities and Trends in Cancer Screening: An Analysis of Behavioral Risk Factor Surveillance System Data (2018-2022).

Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancer screenings. This analysis aimed to examine rural-urban differences in recent trends for being up to date with screenings for breast, cervical, and colorectal cancers. We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible U.S. adults. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year. Prevalence of being up to date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer that dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022 with the odds of up-to-date screening being 14% to 27% lower for rural populations than urban populations. For colorectal and cervical cancer, the odds of being up to date with screenings were lower for rural populations in 2018 and 2020, but there was no significant difference observed in 2022 (colorectal screening OR = 0.96; 95% CI: 0.90, 1.02) (cervical screening OR = 0.97; 95% CI: 0.93, 1.03). There is a concerning trend of decreasing uptake of cancer screenings, which will challenge future efforts in cancer prevention and control efforts. Efforts are needed to better understand factors contributing to the declining uptake of cancer screenings.

Harmonizing data across the accelerating colorectal cancer screening and follow-up through implementation science (ACCSIS) program to enhance data quality and promote data sharing

BackgroundThe purpose of the Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) Program, a Cancer Moonshot℠ Initiative, is to support research to build the evidence base on multilevel interventions that increase rates of colorectal cancer screening, follow-up, and referral to care to address disparities in colorectal cancer screening. The National Cancer Institute funded eight Research Projects to implement multilevel interventions to improve colorectal cancer screening among communities who traditionally have been medically underserved. To analyze the impact of ACCSIS across Research Projects, the consortium developed a set of common data elements. The purpose of this paper is to describe the process of developing the common data elements to facilitate analysis of ACCSIS data as well as support and inform implementation science research studies.MethodsThe ACCSIS Data, Design, and Analysis Work Group was tasked with designing common data elements through a review of existing data collection instruments, examination of data elements proposed by the ACCSIS Research Projects, and deliberations on the data required to compare across the Research Projects. ACCSIS Consortium members drafted, revised, and finalized a common data elements document consisting of variables to collect and surveys to administer to evaluate ACCSIS implementation activities and outcomes in a standardized manner across the Research Projects.ResultsThe ACCSIS Consortium decided to collect the following categories of common data elements: characteristics across multiple levels of the multicomponent interventions, implementation climate, and determinants; interventions and strategies; implementation outcome constructs and definitions; colorectal cancer screening episodes (screening, diagnostic testing follow-up, cancer detection, and cancer treatment); and cost measures. To assess implementation climate, the consortium prioritized constructs from five domains of the Consolidated Framework for Implementation Research.ConclusionsThe ACCSIS common data elements offer a set of harmonization data for future implementation efforts. The consortium is conducting a systematic assessment using both quantitative and qualitative approaches to assess data quality and approaches to improve and sustain data collection. Lessons learned from these ongoing activities will offer additional insights to tailor the ACCSIS common data elements and support efforts to increase colorectal cancer screening for populations experiencing disparities.

Disparities in Colorectal Cancer Screening Before and After the Onset of the COVID Pandemic.

Colorectal cancer (CRC) screening is underutilized among those with lower socioeconomic status and in racial and ethnic minoritized populations who have been disproportionately impacted by COVID. To compare disparities in CRC screening before and after the onset of the COVID pandemic among privately insured individuals. Retrospective cohort study using deidentified claims data from the USA between January 1, 2017, and December 31, 2022. Blue Cross Blue Shield beneficiaries aged 50-75years with average risk of CRC. Mean screening use was compared by demographic and area-level socioeconomic factors between the periods preceding (January 1,2017 to February 28,2020) and following (July 1,2020 to December 31,2022) the onset of the COVID pandemic. Difference-in-differences analysis was used to evaluate changes in screening differences. Our study included 21,724,223 beneficiaries. Compared to males, females had higher screening in both periods (p < 0.05), and this sex difference in screening increased 1.63% (95% confidence interval [CI]: 1.32%, 1.94%) following the onset of the pandemic. Compared to residents in areas with high socioeconomic status (SES), low SES area residents had lower screening (p < 0.001) during both periods. Furthermore, this difference grew 4.32% (95% CI, 3.76%, 4.88%) during the post-onset period. Metropolitan area residents had higher screening than non-metropolitan area residents during both periods (p < 0.001); however, this difference decreased 0.77% (95% CI, 0.34%, 1.20%) during the post-onset period. Among beneficiaries with high risk of CRC, the difference in screening based on social deprivation index and metropolitan area status increased 6.99% (95% CI, 5.77%, 8.20%) and 1.82% (95% CI, 0.88%, 2.74%), respectively. Among privately insured individuals, CRC screening after the COVID pandemic recovered unevenly based on sex, area-level socioeconomic measures, and metropolitan area status, with pre-pandemic disparities persisting and even worsening for some of the factors.

Design of a pragmatic trial integrating human papillomavirus (HPV) self-sampling into primary care to reduce cervical cancer screening disparities in Somali American individuals: The Isbaar project

Design of a pragmatic trial integrating human papillomavirus (HPV) self-sampling into primary care to reduce cervical cancer screening disparities in Somali American individuals: The Isbaar project

Socioeconomic inequalities in cervical cancer screening in sub-Saharan Africa: Decomposition analysis

Abstract Background Cervical cancer remains prevalent in sub-Saharan Africa (SSA). Despite global efforts to eliminate this disease, its incidence continues to rise due to barriers in screening, vaccination, and treatment access. While studies address access barriers, little has explored inequality, often limited to single countries. Here, we examine socioeconomic inequalities in cervical cancer screening in SSA. Methods Data from the Demographic and Health Surveys of 10 SSA countries was used for the analysis. We stratified the study by wealth index and educational attainment as a measure of socioeconomic status. Socioeconomic status inequalities in cervical cancer screening were constructed using concentration curves. We then computed the concentration index to quantify socioeconomic inequality. To examine the factors associated with high socioeconomic inequality in cervical cancer screening, a decomposition analysis was conducted. Results Concentration curves showed screening uptake skewed towards the wealthy and educated across all countries, reflected by positive concentration indices (CIX=0.21; p-value&amp;lt;0.0001) except in Burkina Faso and Mauritius. Decomposition analysis revealed significant positive concentration indices for women with complete secondary (CIX=0.74) and higher education (CIX=0.91), those in the richest wealth index (CIX=0.35), separated women (CIX=0.08), currently working women (CIX=0.02), as well as those who were exposed to reading newspaper/magazine (CIX=0.19), listening to radio (CIX=0.10), and watching TV (CIX=0.44). Conclusions Cervical cancer screening in SSA exhibits pro-rich and pro-higher educational inequalities. Urgent interventions are needed to restructure existing screening programs to prioritize accessibility and inclusion, particularly for women from poorer households and with a lower level of education. These findings are vital for policymakers and public health practitioners to address cervical cancer screening disparities in SSA. Key messages • Addressing socioeconomic inequalities in cervical cancer screening is crucial for improving public health in sub-Saharan Africa. • Combatting socioeconomic disparities in cervical cancer screening is critical for achieving health equity in sub-Saharan Africa.

Discrimination in the medical setting among LGBTQ+ adults and associations with cancer screening.

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals experience disparities in cancer screening. We examined whether experience of LGBTQ+ -related discrimination in medical settings was associated with cancer screening disparities. Participants were recruited via social media for a cross-sectional survey study. Those who self-reported as LGBTQ+ , being 40+ years of age, and residing in the US were eligible. Participants reported their clinical and demographic characteristics, cancer screening history, and experiences of discrimination in a medical setting. We examined the odds (OR) of ever undergoing cancer screening by experienced discrimination, stratified by sex assigned at birth. Participants (n = 310) were on average 54.4 ± 9.0years old and primarily White (92.9%). Most identified as lesbian (38.1%) or gay (40.0%) while 17.1% were transgender or gender diverse. Nearly half (45.5%) reported experiencing LGBTQ+ -related discrimination in the medical setting. Participants assigned female at birth with discriminatory experiences had significantly lower odds of ever undergoing colonoscopy/sigmoidoscopy compared to those without discriminatory experiences (OR: 0.37; 95% Confidence Interval (CI) 0.15-0.90). No significant differences in colonoscopy/sigmoidoscopy uptake were observed in those assigned male at birth by discriminatory experiences (OR: 2.02; 95% CI 0.59-6.91). Pap tests, mammogram, and stool colorectal cancer screening did not differ by discriminatory experience. Discrimination in medical settings was commonly reported by LGBTQ+ individuals in this study. When treating LGBTQ+ patients, clinicians should ask about prior experiences and continue to promote cancer screening. Future studies should examine discrimination as a key driver of LGBTQ+ disparities in cancer screening.

An Intersectional Approach to Cervical Cancer Screening Disparities by Race/Ethnicity and Immigrant Status.

Background: Disparities in cervical cancer (CC) screening exist within racial/ethnic minority and immigrant groups. However, few studies have explored the joint influence of race/ethnicity and immigrant status on screening, and the disparities that have been identified by existing studies remain incompletely explained. This study aims to identify the joint influence of race/ethnicity and immigrant status on CC screening and elucidate the barriers contributing to identified disparities. Methods: A cross-sectional analysis of 25,660 U.S. women from the 2005, 2010, and 2015 National Health Interview Surveys was done. The CC screening up-to-date status of cases was analyzed by race/ethnicity and immigrant status using logistic regression models. Conceptualized mediators were added to models to identify their contribution to identified disparities. Results: All immigrants had lower screening odds than U.S.-born non-Hispanic White women with foreign-born non-Hispanic Asians having the lowest odds (adjusted odds ratio [aOR]: 0.36, 95% confidence interval [CI]: 0.26-0.49) followed by foreign-born non-Hispanic White (aOR: 0.52, 95% CI: 0.36-0.76), Hispanic/Latinx (aOR: 0.58, 95% CI: 0.47-0.73), and non-Hispanic Black women (aOR: 0.62, 95% CI: 0.38-0.99). Adjusting for only socioeconomic status or access to care attenuated the aOR: for foreign-born Hispanic/Latinx and non-Hispanic Black women only. Adjusting simultaneously for language and acculturation attenuated the aOR: for all immigrants. Conclusions: Disparities in CC screening were only found in the immigrant populations of various racial/ethnic groups. Targeting insurance and health care access may address disparities in immigrant Hispanic/Latinx and non-Hispanic Black women. Focusing on culturally and linguistically competent care and education may be more crucial for immigrant non-Hispanic Asian and White women.

Health screening disparities in people living with HIV; A nationwide organized screening setting

BackgroundWe identified the uptake of people living with HIV (PLWH) using health-screening services and compared the screening rate with the general population, to identify factors associated with the use of screening services by PLWH. MethodsThis population-based study used data from the Korean National Health Insurance, a single mandatory health insurance system covering all residents. The uptake rates for screening for general health, gastric cancer, and colorectal cancer, which were provided by a national health screening program with free of charge or minimal cost in Korea from 2010–2020. Factors associated with general health, gastric cancer, and colorectal cancer screening were also explored. ResultsScreening uptake rates for general health, gastric cancer, and colorectal cancer in PLWH increased from 2010–2019 but decreased in 2020. The standardized screening ratio showed lower screening rates for general health, gastric cancer, and colorectal cancer in PLWH with 0.80 (95 % confidence interval (CI) = 0.77–0.83), 0.64 (95 % CI = 0.61–0.67), and 0.67 (95 % CI = 0.64–0.71) in 2019. Increased age, Charlson Comorbidity Index, and years since HIV diagnosis were associated with increased screening uptake in PLWH. Otherwise, PLWH recipients of medical aid programs received less for each screening compared to PLWH who paid insurance premiums higher than 50 %. An increased medication possession ratio of highly active antiretroviral therapy was associated with decreased general health and gastric cancer screening uptake but increased colorectal cancer screening uptake. ConclusionsSignificant disparities in health-screening uptake were observed in PLWH compared to the general population in a nationwide organized screening setting without cost barriers.

Disparities in screening and risk stratification for hispanic adults with metabolic dysfunction-associated steatotic liver disease.

Cut-points for non-invasive tests (NITs) for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD) were derived from predominantly non-Hispanic populations. It is unknown if these cut-points perform adequately in Hispanic individuals. We assessed the performance characteristics of current NIT cut-points among Hispanic patients and determined whether they could be further optimized. We prospectively enrolled 244 adults with biopsy-proven MASLD. Participants underwent a research visit with magnetic resonance elastography (MRE) and vibration controlled transient elastography (VCTE). Histology and imaging assessments were conducted centrally. Diagnostic performance was evaluated by area under the receiver-operating curve (AUROC) and optimal cut-points were identified by Youden J analysis. The mean (±SD) age and body mass index were 52.6 (±13) and 31.6 (±4.6) kg/m2. Overall, 40% had diabetes, 31% (N=75) were Hispanic. 40% of Hispanic and 28.4% of non-Hispanic patients had significant fibrosis. To detect significant fibrosis, MRE and VCTE exhibited significantly lower accuracy in Hispanic versus non-Hispanic participants (AUROC: MRE, 0.87 vs. 0.98, p=0.01; VCTE, 0.78 vs. 0.92, p=0.02). Clinical care algorithms yielded high false-negative rates among Hispanic participants (14% with low-risk FIB-4 and 21% with low-risk VCTE had advanced fibrosis on biopsy). Cut-points of 2.73kPa for MRE and 6.9kPa for VCTE were optimal to detect significant fibrosis in Hispanic individuals. Findings were validated in a Latin American cohort. Lower NIT cut-points may be needed to optimize surveillance for significant fibrosis due to MASLD in Hispanic populations commensurate with their higher burden and severity of disease.

Colorectal Cancer Screening and Management in Low- and Middle-Income Countries and High-Income Countries: A Narrative Review.

Colorectal cancer (CRC) remains a leading global health challenge, being a highly prevalent cancer and a major cause of cancer-related deaths worldwide. The incidence of CRC varies significantly between high-income countries (HICs) and low- and middle-income countries (LMICs), with higher rates of incidence but lower mortality in HICs. Factors such as genetic predisposition, lifestyle, and dietary habits play significant roles in CRC development, with the Western diet and limited access to screening contributing to increased incidence. This review highlights disparities in CRC screening, management, and outcomes between HICs and LMICs, with HICs benefiting from advanced screening methods like colonoscopy and sigmoidoscopy, while LMICs face challenges due to limited healthcare infrastructure and resources. Tailored strategies, including low-cost screening options and community-based initiatives, are critical in LMICs to improve early detection and outcomes. Future directions for improving CRC care globally include telemedicine, artificial intelligence, and mobile health technologies to bridge access gaps, as well as personalized medicine to enhance treatment efficacy. Global collaboration and investment in healthcare infrastructure are necessary to reduce CRC-related mortality, particularly in resource-limited settings.

Housing-related disparities in receipt of breast cancer screening among Medicaid beneficiaries.

76 Background: People experiencing or at risk of homelessness (PEH) are often diagnosed with advanced breast cancer, suggesting barriers to preventive care and screening. However, there is limited data that examine screening among PEH, undermining efforts to characterize and address potential disparities in screening. To address this gap, we investigated housing-related disparities in receipt of breast cancer screening in Medicaid, which disproportionately serves low-income PEH. Methods: We used a novel linkage of Pennsylvania Medicaid data with encounter-level data on housing-related services (Housing Management Information System; HMIS) from 2011 to 2017. We compared rates of biennial mammography between a cohort of Medicaid women receiving housing-related services in HMIS (i.e., a proxy for experience/risk of homelessness) and randomly sampled comparison beneficiaries without any housing services use. We estimated both unadjusted and adjusted disparities in receipt of biennial mammography (controlled for county and year fixed effects, demographic and Medicaid eligibility characteristics, and baseline healthcare utilization and comorbidities). We also examined heterogeneity in disparities by beneficiaries in the following HMIS subgroups: 1) receiving supportive housing, 2) experiencing chronic homelessness (i.e., 12+ months of homelessness), and 3) unstably housed (housed but receiving homelessness prevention services). Results: We identified 1,792 Medicaid beneficiaries with an HMIS encounter and 71,664 comparison beneficiaries. Those in the HMIS cohort were more likely to be younger, non-Hispanic Black, eligible for Medicaid due to disability, and have a higher number of inpatient visits and comorbidities. The unadjusted proportion receiving mammogram was 44.8% and 50.1% in the HMIS vs. comparison cohort, with an overall disparity of 5.3 percentage-points (pp, P &lt;.001). This disparity estimate remained was robust to adjusting for covariates (-4.3 pp; P &lt; .001). We found the largest adjusted disparity when comparing beneficiaries experiencing chronic homelessness (-8.5 pp; P = .038) relative to the comparison cohort. In contrast, the disparity was smaller among women receiving supportive housing (-3.7 pp; P = .098) and unstably housed women (-3.3 pp; P = .071). Conclusions: There was a significant disparity in the utilization of mammography among women PEH, especially those who experience chronic homelessness, in Pennsylvania Medicaid. Our finding illuminates the health consequences of housing insecurity and underscore a need for programs providing adequate housing, such as supportive housing, to address disparities in screening. In the meantime, greater efforts should be dedicated to improving the uptake of screening among at-risk populations at the point of contact with the healthcare system (e.g. when PEH engage with care).

Ethnic and racialized disparities in the use of screening services for pap smears and mammograms in Canada.

Breast and cervical cancers pose significant health challenges for women globally, emphasizing the critical importance of effective screening programs for early detection. In Canada, despite the implementation of accessible healthcare systems, ethnic and racialized disparities in cancer screening persist. This study aims to assess ethnic and racialized disparities in breast and cervical cancer screening in Canada. Using 2015-2019 data from the Canadian Community Health Survey, we analyzed women aged 18-70 in distinct ethnic and racial groups. The primary outcome was mammography or Papanicolaou test (pap smear). The secondary outcome was time since the last screening. We used weighted multivariable logistic regression to estimate the odds of having a pap smear or mammography across the ethnic and racialized groups, adjusted for relevant covariates. Results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). We included 14,628,067 women of which 72.5% were White, 8.4% Southeast Asian, 4.7% South Asian, 3.4% Indigenous, 2.7% Black, 2.0% West Asian, and 1.6% Latin American. In comparison with the White reference group, a higher odds ratio of not having a pap smear was estimated for the West Asian (5.63; CI 3.85, 8.23), South Asian (5.19; CI 3.79, 7.12), Southeast Asian (4.35; CI 3.46, 5.46), and Black groups (2.62; CI 1.82, 3.78). Disparities in mammography screening were found only for the Southeast Asian group with higher odds of not having screening (1.85; CI 1.15, 2.98) compared to the White reference group. This study reveals significant disparities in pap smear and mammography screenings affecting various ethnic groups, particularly in West Asia, South Asian, and Black communities. These findings underscore the urgent need for targeted interventions, policies, and healthcare strategies to address these gaps and ensure equitable access to essential breast and cervical cancer prevention across all ethnicity.

Disparities in mental health screening for veteran women with a new diagnosis of breast cancer.

222 Background: Compared to the general population, mental health disorders, including depression, are higher for Veteran women. Breast cancer (BC) is the most commonly diagnosed cancer in this population and up to 50% of women will experience depressive symptoms after diagnosis, associated with poor prognosis and survival. An increasing number of Veteran women live in rural areas, where access to behavioral health care may be limited. This study sought to evaluate rural disparities in mental health screening and follow-up evaluation after a new BC diagnosis. Methods: Women Veterans with a new BC diagnosis were identified between 2017 and 2021. Data for mental health screenings [Patient Health Questionnaire (PHQ)-2, PHQ-9, General Anxiety Disorder-7] were collected subsequent to the first BC diagnosis. Rurality was defined per the USDA Rural-Urban Commuting Area (RUCA) codes framework to determine rurality based on population density and commuting patterns. Data were abstracted from several large VA and non-VA datasets, including the Corporate Data Warehouse (CDW) Outpatient files, non-VA Care Medical and Pharmacy System files, Program Integrity Tool, and VA Informatics and Computing Infrastructure for Oncology. Rurality data was specified using CDW designations combined with ZIP-code-level USDA RUCA information. All categorical variables were analyzed using chi-square tests. Means were tested using t-tests. Results: 14,225 Veteran women with a new BC diagnosis were identified. The mean age was 63.4 (SD 11.7). The most common documented race was White (30.6%), followed by Black (15.7%). 59.6% lived in an urban setting as opposed to rural setting (40.4%). In the entire population, only 14% had a mental health screening within 3 months of a cancer diagnosis. Veteran women living in an urban setting were more likely to be screened compared to those living in a rural setting (17.4% vs 9.2%, p &lt; 0.001). For women screened within 3 months, most screened negative, regardless of rurality (76.1% rural, 75.7% urban). Of women who had a positive mental health screen within 3 months, only approximately one-third (31.8% rural, 34.2% urban) had additional screening regardless of rurality. However, for those with a negative initial screen, urban Veterans were more likely to have any additional screening (17% vs 10.2%, p = 0.001). PHQ-2 was the most common mental health screening tool used (73.8%) followed by a combination of PHQ-9 and GAD-7 (9.6%). Conclusions: Mental health screening within 3 months of breast cancer diagnosis is low for Veteran women. There is a significant difference in screening between rural and urban populations. It is critical to both improve mental health screening overall in this population and bridge the disparity gap between screening in rural and urban Veteran women. This may impact not only mental health but also breast cancer outcomes during the period encompassing treatment and survivorship.

Disparities in Screening for Substance Use Among Injured Adolescents

Disparities in Screening for Substance Use Among Injured Adolescents

USPSTF Colorectal Cancer Screening Recommendation and Uptake for Individuals Aged 45 to 49 Years

In May 2021, the US Preventive Services Task Force (USPSTF) issued a grade B recommendation encouraging colorectal cancer (CRC) screening among average-risk individuals aged 45 to 49 years. The patterns of screening uptake and possible socioeconomic disparities in screening in this age group remain unknown. To evaluate changes in CRC screening uptake among average-risk individuals aged 45 to 49 years after the USPSTF recommendation was issued in 2021. This retrospective cohort study used deidentified claims data from commercially insured Blue Cross Blue Shield beneficiaries aged 45 to 49 years across the US between January 1, 2017, and December 31, 2022. Publication of the May 2021 USPSTF CRC screening recommendation for adults aged 45 to 49 years. Absolute and relative changes in screening uptake were compared between a 20-month period preceding (May 1, 2018, to December 31, 2019) and a 20-month period following (May 1, 2021, to December, 31, 2022) the USPSTF recommendation. Interrupted time-series analysis and autoregressive integrated moving average models were used to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality. In this cohort study of 10 221 114 distinct beneficiaries aged 45 to 49 years (mean [SD] age, 47.04 [1.41] years; 51.04% female), bimonthly mean (SD) numbers of average-risk beneficiaries were 3 213 935 (31 508) and 2 923 327 (105 716) in the prerecommendation and postrecommendation periods, respectively. Mean (SD) screening uptake increased from 0.50% (0.02%) to 1.51% (0.59%) between the 2 periods (P < .001), representing an absolute change of 1.01 percentage points (95% CI, 0.62-1.40 percentage points) but no significant relative change (202.51%; 95% CI, -30.59% to 436.87%). Compared with average-risk beneficiaries residing in areas with the lowest socioeconomic status (SES), those residing in areas with the highest SES experienced the largest absolute change in screening (1.25 [95% CI, 0.77-1.74] percentage points vs 0.75 [95% CI, 0.47-1.02] percentage points), but relative changes were not significant (214.01% [95% CI, -30.91% to 461.15%] vs 167.73% [95% CI, -16.30% to 352.62%]). After the recommendation was issued, the screening uptake rate also increased fastest among average-risk beneficiaries residing in the areas with highest SES (0.24 [95% CI, 0.23-0.25] percentage points every 2 months) and metropolitan areas (0.20 [95% CI, 0.19-0.21] percentage points every 2 months). This study found that among privately insured beneficiaries aged 45 to 49 years, CRC screening uptake increased after the USPSTF recommendation, with potential disparities based on SES and locality.

P2.04A.06 A Multilevel Approach to Address Disparities in Lung Cancer Screening: The PREP Trial

P2.04A.06 A Multilevel Approach to Address Disparities in Lung Cancer Screening: The PREP Trial

352 - Disparity in LDCT Lung Cancer Screening among Family History of Lung Cancer and Heavy Smoking

352 - Disparity in LDCT Lung Cancer Screening among Family History of Lung Cancer and Heavy Smoking

Racial Disparities in Parturient Urine Drug Screening at a Texas Level IV Maternal Care Centre: A Single-Centre Retrospective Study

ObjectivesWe hypothesized that Black or African American (hereby referred to as Black) and Hispanic patients would have higher rates of urine drug screening (UDS) during pregnancy compared with White or Caucasian (herby referred to as White) patients at our hospital. MethodsPatients who delivered at our hospital between 1 December 2020 and 31 May 2021 and between 1 December 2022 and 31 May 2023 and who were Black, Hispanic, or White were included in the final analysis. We performed separate bivariate analyses comparing White patients to either Black patients or Hispanic patients. We performed a multivariate logistic regression, including variables of interest designed to predict risk factors for UDS during pregnancy. ResultsA total of 457 Black, 813 Hispanic, and 1252 White patients were identified. During pregnancy, 187 (40.9%) Black patients had UDS compared with 265 (21.2%) White patients (P < 0.001). In addition, 258 (31.7%) Hispanic patients had UDS during pregnancy, which was statistically different compared with White patients (P < 0.001). A multivariate logistic regression found that identification as Black was independently associated with UDS during pregnancy (adjusted OR [aOR] 1.871; 95% CI 1.382–2.534, P < 0.001), identification as Hispanic was not independently associated (aOR 1.177; 95% CI 0.900–1.538, P = 0.234), and patients who delivered after the COVID-19 pandemic were less likely to receive UDS (aOR 0.783; 95% CI 0.621–0.987, P = 0.039). ConclusionIdentification as Black and delivery during the COVID-19 pandemic were independently associated with increased adjusted odds of UDS during pregnancy at our hospital.

General Obesity and Prostate Cancer in Relation to Abdominal Obesity and Ethnic Groups: A US Population-Based Cross-Sectional Study.

Research suggests inconsistent evidence regarding the association between general obesity and prostate cancer among men in the United States. This study aimed to examine whether the association between general obesity and prostate cancer is influenced by abdominal obesity and ethnic groups. The study utilized data from the National Health and Nutrition Examination Survey (NHANES). The analysis was restricted to non-Hispanic men (10,683 White and 6,020 Black). Obesity was defined as body mass index (BMI) ≥30 and abdominal obesity as waist circumference (WC) ≥102 cm. No significant difference was identified in the overall prevalence of prostate cancer between obese and non-obese (2.14% vs 2.25%, P = 0.678). When both obesity measures were combined, the general and abdominal obesity category was associated with a significant increase in the odds of prostate cancer in Black men [odds ratio (OR) = 1.49, 95% confidence interval (CI) (1.09, 2.04)], but not in White men [OR = 1.29, 95% CI (0.91, 1.82)]. In both Black [OR = 2.46, 95% CI (1.48, 4.06)] and White men [OR = 1.60, 95% CI (1.16, 2.21)], abdominal obesity was associated with significant increase in the odds of prostate cancer. The association between general obesity and prevalence of prostate cancer depends on abdominal obesity and ethnic groups. Our study utilized a nationally representative survey and emphasized the potential of combined effect of general and abdominal obesity as a modifiable factor to decrease racial disparity in prostate cancer screening and poor outcomes.