Disparities In Screening Research Articles

Disparities in Cancer Screening in Sexual and Gender Minority Populations: A Secondary Analysis of Behavioral Risk Factor Surveillance System Data.

To describe cancer screening characteristics and better understand individual-, environmental-, and organizational-level barriers of sexual and gender minority (SGM) populations.&nbsp. This study was conducted using a combined sample from the Behavioral Risk Factor Surveillance System (BRFSS) national dataset from 2014 and 2016. Chi-square tests for independence and logistic regression analysis tests were performed to determine whether relationships existed between SGM status and demographics. Black respondents or those who reported their race as other, were female, had some college or technical school or more, and had healthcare coverage were less likely to present for cancer screening. SGM respondents who were in good or better health; were unmarried; were aged 18-44 years or 45-55 years; or were Asian, Native American, or Hawaiian, or reported their race as other, had higher odds of screening for cancer. Disparities in cancer screening among SGM populations are not well documented. These findings will inform structured education and preventative interventions to improve screening participation among SGM populations.

Disparities in Colorectal Cancer Screening by Time in the U.S. and Race/Ethnicity, 2010−2018

Longer time lived in the U.S. has been associated with worse health outcomes, especially preventable diseases, among racially and ethnically diverse groups of foreign-born individuals. This study evaluated the association between time lived in the U.S. and colorectal cancer screening adherence and whether this relationship differed by race and ethnicity. Data from the National Health Interview Survey for 2010-2018 among adults aged 50-75 years were used. Time in the U.S. was categorized as U.S.-born, foreign-born ≥15 years, and foreign-born <15 years. Colorectal cancer screening adherence was defined according to U.S. Preventive Services Task Force guidelines. Generalized linear models with Poisson distribution were used to calculate adjusted prevalence ratios and 95% CIs. Analyses were conducted in 2020-2022, were stratified by race and ethnicity, accounted for the complex sampling design, and were weighted to be representative of the U.S. Prevalence of colorectal cancer screening adherence was 63% overall, 64% for U.S.-born, 55% for foreign-born ≥15 years, and 35% for foreign-born <15 years. In fully adjusted models for all individuals, only foreign-born <15 years had lower adherence than U.S.-born (foreign-born≥15 years: prevalence ratio=0.97 [0.95, 1.00], foreign-born <15 years: prevalence ratio=0.79 [0.71, 0.88]). Results differed by race and ethnicity (p-interaction=0.002). In stratified analyses, findings for non-Hispanic White individuals (foreign-born ≥15 years: prevalence ratio=1.00 [0.96, 1.04], foreign-born <15 years: prevalence ratio=0.76 [0.58, 0.98]) and non-Hispanic Black individuals (foreign-born ≥15 years: prevalence ratio=0.94 [0.86, 1.02], foreign-born <15 years: prevalence ratio=0.61 [0.44, 0.85]) were similar to all individuals. Disparities by time in the U.S. were not observed among Hispanic/Latino individuals (foreign-born ≥15 years: prevalence ratio=0.98 [0.92, 1.04], foreign-born <15 years: prevalence ratio=0.86 [0.74, 1.01]) but persisted among Asian American/Pacific Islander individuals (foreign-born ≥15 years: prevalence ratio=0.84 [0.77, 0.93], foreign-born <15 years: prevalence ratio=0.74 [0.60, 0.93]). The relationship between colorectal cancer screening adherence and time in the U.S. varied by race and ethnicity. Culturally and ethnically tailored interventions are needed to improve colorectal cancer screening adherence among foreign-born people, especially among the most recently immigrated individuals.

Racial and ethnic disparities in cervical and breast cancer screenings by nativity and length of U.S. residence

ABSTRACT Objective Previous studies of disparities in breast and cervical cancer screenings have focused on broad racial/ethnic groups or nativity status without accounting for immigration histories. Recent theoretical work argues for using intersectional approaches and examining within-group inequalities. Utilizing multiple years of National Health Interview Survey (NHIS) data, we examined between- and within-group Papanicolaou (Pap) test and mammogram screening based on nativity and length of U.S. residence for Asian and Hispanic women, along with non-Hispanic Black and White women. Design The study samples consist of 54,900 women ages 21–64 without a hysterectomy who responded to questions about Pap test screening and 36,300 women ages 40–64 who responded to questions about mammogram screening. Asian and Hispanic women were further stratified by nativity and, for immigrants, length of time in the United States. Logistic regression analysis was used to identify significant associations with Pap test and mammogram screenings. Results Recent Asian and Hispanic immigrants had the lowest Pap test and mammogram rates among all other groups, while Black (and White women for mammograms) women had the highest rates. After accounting for age, marital status, health insurance, education, employment status, and income, both Asian groups had lower odds, and Black and all Hispanic groups had higher odds of Pap test screening compared with White women. Similar results were observed for mammogram screening, except that long-term immigrant/U.S.-born Asian and U.S.-born Hispanic women did not have significantly different odds compared with White women. In general, the strength and direction of most sociodemographic variables were similar across groups for Pap test screening but differed for mammogram screening. Conclusions The between-group differences identified emphasize the disparities in screening between racial/ethnic groups while the within-group differences suggest the need to examine whether more targeted outreach efforts and prevention messages can increase screening for specific groups.

Data Challenges in Identifying Patients Due for Colorectal Cancer Screening in Rural Clinics.

Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents despite the availability of effective screening methods. Outreach activities can improve CRC screening rates but rely on accurate identification of patients due for screening. We report on data challenges in rural clinics and Medicaid health plans in Oregon in identifying patients eligible for CRC screening, in a large project implementing mailed fecal immunochemical tests (FIT) and patient navigation. We analyzed data from clinic intake surveys and administrative claims. Clinics were asked to identify total population numbers relevant to CRC screening and follow-up. Health plans also identified enrollees eligible for CRC screening in Spring, 2021. Clinic staff validated patient lists for eligibility using their electronic health records (EHR). EHR features varied across the 29 participating and 28 responding clinics. Among the 28 responding clinics, 21 were able to report their Medicaid population (75%), 19 reported the number of patients aged 50 to 75 (68%) and the number screened for CRC in the last year (68%). Only 8 (29%) were able to report screening details such as number screened by FIT and 9 were able to report on patients with an abnormal FIT or colonoscopy completed after FIT (32%). Health plans had challenges properly identifying where enrollees received care and had missing data for race and ethnicity (range 22 to 34% unknown race, <1% to 24% unknown ethnicity). Most participating rural primary care clinics and Medicaid health plans experienced challenges identifying the population due for a CRC screening outreach program. Better EHR functionality and data reporting capabilities could help rural clinics apply population-based strategies and ultimately attenuate disparities in cancer screening and follow-up.

Screening for Hepatitis C Among Community Health Center Patients by Ethnicity and Language Preference

Hepatitis C virus is associated with high morbidity and mortality-chronic liver disease is a leading cause of death among Latinos in the U.S. Screening for hepatitis C virus in community health center settings, which serve a disproportionate percentage of Latinos, is essential to eradicating hepatitis C virus infection. We assessed hepatitis C virus screening disparities in adults served by community health centers by ethnicity and language preference. This was an observational cohort study (spanning 2013-2017) of adults born in 1945-1965 in the Accelerating Data Value Across a National Community Health Center Network electronic health record data set. Our exposure of interest was race/ethnicity and language preference (non-Hispanic White, Latino English preferred, Latino Spanish preferred). Our primary outcome was the relative hazard of hepatitis C virus screening, estimated using multivariate Cox proportional hazards regression. A total of 182,002 patients met the study criteria and included 60% non-Hispanic Whites, 29% Latino Spanish preferred, and 11% Latino English preferred. In total, 9% received hepatitis C virus screening, and 2.4% were diagnosed with hepatitis C virus. Latino English-preferred patients had lower rates of screening than both non-Hispanic Whites and Latino Spanish preferred (5.5% vs 9.4% vs 9.6%, respectively). Latino English preferred had lower hazards of hepatitis C virus screening than non-Hispanic Whites (adjusted hazard ratio=0.56, 95% CI=0.44, 0.72), and Latino Spanish preferred had similar hazards of hepatitis C virus screening (adjusted hazard ratio=1.11, 95% CI=0.88, 1.41). We found that in a large community health center network, adult Latinos who preferred English had lower hazards of hepatitis C virus screening than non-Hispanic Whites, whereas Latinos who preferred Spanish had hazards of screening similar to those of non-Hispanic Whites. The overall prevalence of hepatitis C virus screening was low. Further work on the role of language preference in hepatitis C virus screening is needed to better equip primary care providers to provide this recommended preventive service in culturally relevant ways.

Disparities in colorectal cancer: Trends of reduced screening among minority populations.

18 Background: Studies have shown that African Americans (AA) are at increased risk for Colorectal Cancer (CRC) compared to other groups. Despite advancements in CRC screening modalities, few studies have investigated disparities in CRC screening among this vulnerable population. Methods: We performed a retrospective review of patients of age 45 or older who were seen in Family Medicine (FM), Internal Medicine (IM), or Gastroenterology (GI) between January 1, 2015 and December 31, 2021 at the Mayo Clinic. Information was collected regarding patient characteristics (age, sex, Charlson comorbidity score, race), and outcomes (whether a Cologuard test was ordered on the same day as the initial appointment, and whether the patient underwent a colonoscopy within 1 year after the initial appointment). Categorical variables were summarized with number and percentage of patients. Outcomes were compared between race groups (Caucasian, AA, Asian, Other) using unadjusted and multivariable logistic regression models. Multivariable models were adjusted for age, sex, and Charlson comorbidity score. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. P-values &lt;0.05 were considered as statistically significant, and all statistical tests were two-sided. Results: Overall, 558,078 were included for analysis and 14,607 (2.6%) were AA. Overall, AA patients for less likely to have Cologuard ordered compared to Caucasians (OR=0.62, p&lt;0.001), notably driven by patient seen in the FM group (OR=0.54, p&lt;0.001) and no statistically significant difference was observed in the IM and GI groups (p=0.055 and p=0.43, respectively). Notably, compared to Caucasian patients, Asian patients were overall more likely to have Cologuard ordered (OR=1.23, p=0.003). In multivariable analysis assessing the likelihood of having a colonoscopy performed within 1 year of the initial appointment, the likelihood of a colonoscopy within 1 year of initial clinic visit was significantly lower for AA compared to Caucasian patients (OR=0.50, p=0.028). This difference was strongest in FM patients (OR=0.26, p=0.022) and was not significant for IM (OR=0.67, p=0.37) or GI (OR=2.31, p=0.25). Conclusions: In this study, we found that AA ethnicity is associated with reduced likelihood of having Cologuard ordered compared to Caucasian patients. Furthermore, AA patients were less likely to have colonoscopy ordered within 1 year of initial visit clinic visit among the overall cohort, highlighting important disparities in CRC screening among this vulnerable patient population notably for those seen in the FM group. Future studies are needed to assess other barriers for CRC screening in this population.

Effect of shared decision making on racial and ethnic disparity in prostate cancer screening: Results from a national behavioral survey

Effect of shared decision making on racial and ethnic disparity in prostate cancer screening: Results from a national behavioral survey

Colorectal Cancer Screening Disparities Among Race: A Zip Code Level Analysis

BackgroundColorectal cancer (CRC) screening can prevent disease by early identification. Existing disparities in CRC screening have been associated with factors including race, socioeconomic status, insurance, and even geography. Our study takes a deeper look into how social determinants related to zip code tabulation areas affect CRC screenings. Materials and MethodsWe conducted a retrospective cross-sectional study of CRC screenings by race at a zip code level, evaluating for impactful social determinant factors such as the social deprivation index (SDI). We used publicly available data from CDC 500 Cities Project (2016-2019), PLACES Project (2020), and the American Community Survey (2019). We conducted multivariate and confirmatory factor analyses among race, income, health insurance, check-up visits, and SDI. ResultsIncreasing the tertile of SDI was associated with a higher likelihood of being Black or Hispanic, as well as decreased median household income (P < .01). Lower rates of regular checkup visits were found in the third tertile of SDI (P < .01). The multivariate analysis showed that being Black, Hispanic, lower income, being uninsured, lack of regular check-ups, and increased SDI were related to decreased CRC screening. In the confirmatory factor analysis, we found that SDI and access to insurance were the variables most related to decreased CRC screening. ConclusionOur results reveal the top 2 factors that impact a locality's CRC screening rates are the social deprivation index and access to health care. This data may help implement interventions targeting social barriers to further promote CRC screenings within disadvantaged communities and decrease overall mortality via early screening.

Alcohol Use, Screening, and Brief Intervention Among Pregnant Persons — 24 U.S. Jurisdictions, 2017 and 2019

Alcohol use during pregnancy is a major preventable cause of adverse alcohol-related outcomes, including birth defects and developmental disabilities.* Alcohol screening and brief intervention (ASBI) is an evidence-based primary care tool that has been shown to prevent or reduce alcohol consumption during pregnancy; interventions have resulted in an increase in the proportion of pregnant women reporting abstinence (odds ratio=2.26; 95% CI = 1.43-3.56) (1). Previous national estimates have not characterized ASBI in populations of pregnant persons. Using 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) data, CDC examined prevalence of ASBI and characteristics of pregnant persons and nonpregnant women aged 18-49 years (reproductive-aged women) residing in jurisdictions that participated in the BRFSS ASBI module. During their most recent health care visit within the past 2 years, approximately 80% of pregnant persons reported being asked about their alcohol use; however, only 16% of pregnant persons who self-reported current drinking at the time of the survey (at least one alcoholic beverage in the past 30 days) were advised by a health care provider to quit drinking or reduce their alcohol use. Further, the prevalence of screening among pregnant persons who did not graduate from high school was lower than that among those who did graduate from high school or had at least some college education. This gap between screening and brief intervention, along with disparities in screening based on educational level, indicate missed opportunities to reduce alcohol use during pregnancy. Strategies to enhance ASBI during pregnancy include integrating screenings into electronic health records, increasing reimbursement for ASBI services, developing additional tools, including electronic ASBI, that can be implemented in a variety of settings (2,3).

Increasing Racial and Ethnic Equity, Diversity, and Inclusion in Cancer Treatment Trials: Evaluation of an ASCO-Association of Community Cancer Centers Site Self-Assessment.

Clinical trial participants do not reflect the racial and ethnic diversity of people with cancer. ASCO and the Association of Community Cancer Centers collaborated on a quality improvement study to enhance racial and ethnic equity, diversity, and inclusion (EDI) in cancer clinical trials. The groups conducted a pilot study to examine the feasibility, utility, and face validity of a two-part clinical trial site self-assessment to enable diverse types of research sites in the United States to (1) review internal data to assess racial and ethnic disparities in screening and enrollment and (2) review their policies, programs, procedures to identify opportunities and strategies to improve EDI. Overall, 81% of 62 participating sites were satisfied with the assessment; 82% identified opportunities for improvement; and 63% identified specific strategies and 74% thought the assessment had potential to help their site increase EDI. The assessment increased awareness about performance (82%) and helped identify specific strategies (63%) to increase EDI in trials. Although most sites (65%) were able to provide some data on the number of patients that consented, only two sites were able to provide all requested trial screening, offering, and enrollment data by race and ethnicity. Documenting and evaluating such data are critical steps toward improving EDI and are key to identifying and addressing disparities more broadly. ASCO and Association of Community Cancer Centers will partner with sites to better understand their processes and the feasibility of collecting screening, offering, and enrollment data in systematic and automated ways.

Racial and Ethnic Disparities in Opioid Access and Urine Drug Screening Among Older Patients With Poor-Prognosis Cancer Near the End of Life.

To characterize racial and ethnic disparities and trends in opioid access and urine drug screening (UDS) among patients dying of cancer, and to explore potential mechanisms. Among 318,549 non-Hispanic White (White), Black, and Hispanic Medicare decedents older than 65 years with poor-prognosis cancers, we examined 2007-2019 trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life (EOL), defined as 30 days before death or hospice enrollment. We estimated the effects of race and ethnicity on opioid access, controlling for demographic and clinical factors. Models were further adjusted for socioeconomic factors including dual-eligibility status, community-level deprivation, and rurality. We similarly explored disparities in UDS. Between 2007 and 2019, White, Black, and Hispanic decedents experienced steady declines in EOL opioid access and rapid expansion of UDS. Compared with White patients, Black and Hispanic patients were less likely to receive any opioid (Black, -4.3 percentage points, 95% CI, -4.8 to -3.6; Hispanic, -3.6 percentage points, 95% CI, -4.4 to -2.9) and long-acting opioids (Black, -3.1 percentage points, 95% CI, -3.6 to -2.8; Hispanic, -2.2 percentage points, 95% CI, -2.7 to -1.7). They also received lower daily doses (Black, -10.5 MMED, 95% CI, -12.8 to -8.2; Hispanic, -9.1 MMED, 95% CI, -12.1 to -6.1) and lower total doses (Black, -210 MMEs, 95% CI, -293 to -207; Hispanic, -179 MMEs, 95% CI, -217 to -142); Black patients were also more likely to undergo UDS (0.5 percentage points; 95% CI, 0.3 to 0.8). Disparities in EOL opioid access and UDS disproportionately affected Black men. Adjustment for socioeconomic factors did not attenuate the EOL opioid access disparities. There are substantial and persistent racial and ethnic inequities in opioid access among older patients dying of cancer, which are not mediated by socioeconomic variables.

Abstract C083: Exploring relationships between neighborhood social vulnerability and cancer screening in Miami-Dade County

Abstract Purpose: Social and structural contributors to social vulnerability have been associated with cancer disparities across the continuum. This study aimed to explore relationships between indicators of neighborhood social vulnerability and participation in breast, cervical and colorectal cancer screening in Miami-Dade County. Methods: Data were obtained at the census tract level from the United States Census Bureau American Community Survey (2014-2018), the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (2018), and the CDC PLACES dataset (2018). This analysis was restricted to Miami-Dade census tracts for which PLACES data was available on mammography (n=135), cervical cancer screening (n=115), and colorectal screening (n=136) participation. Census tracts were stratified into tertiles based on screening participation, then social vulnerability indicators were assessed among the tertiles. Principal component analysis (PCA) was used to identify characteristics responsible for most variability in breast, cervical and colorectal cancer screening. Results: Mammography participation was 51.76%, 58.80%, and 65.65% in the lower, middle, and upper tertiles, respectively. Among these tracts, per capita income (p&amp;lt;.001), earning an income below poverty (p&amp;lt;.001), educational attainment below earning an HS diploma (p&amp;lt;.001), the proportion of non-Hispanic White residents (p&amp;lt;.001), unemployed residents (p&amp;lt;.001), residents with a disability (p&amp;lt;.001), and people with no computer or limited access to the internet (p&amp;lt;.001) were significantly different between the tertiles. Cervical cancer screening participation was 79.60%, 84.36%, and 87.80% in the lower, middle, and upper tertiles, respectively. Among these tracts, per capita income (p&amp;lt;.001), earning an income below poverty (p&amp;lt;.001), educational attainment below earning an HS diploma (p&amp;lt;.001), and proportion of single-parent households with children under age 17 (p&amp;lt;.001), non-Hispanic White residents (p&amp;lt;.001), unemployed residents (p&amp;lt;.001), residents with a disability (p&amp;lt;.001), and people with no computer or limited access to the internet (p&amp;lt;.001) were significantly different between the screening tertiles. Colorectal cancer screening participation was 79.26%, 81.06%, and 85.26% in the lower, middle, and upper tertiles, respectively. Among these tracts, per capita income (p&amp;lt;.01), earning an income below poverty (p&amp;lt;.004), educational attainment below earning an HS diploma (p&amp;lt;.001), the proportion of residents with a disability (p&amp;lt;.001), and people with no computer or limited access to the internet (p&amp;lt;.001) were significantly different between the screening tertiles. Conclusions: These data suggest that social vulnerability is associated with cancer screening uptake, namely mammography, cervical cancer screening, and colorectal cancer screening. Further investigation of the social and structural factors contributing to disparities in cancer screening will help appropriately allocate resources and craft effective interventions to reduce the burden of cancer among those most vulnerable. Citation Format: Kilan C. Ashad-Bishop, Jordan A. Baeker-Bispo, Zinzi D. Bailey, Erin K. Kobetz. Exploring relationships between neighborhood social vulnerability and cancer screening in Miami-Dade County [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C083.

Abstract A017: Identifying priority neighborhoods for mobile cancer screening using georeferenced data

Abstract Background: Mobile screening units (MSUs) are an evidence-based approach known to reduce barriers and increase access to preventive services such as cancer screening. Less is known about how to plan and prioritize where MSUs are deployed to maximize impact and reduce the burden of disease. We used a geographic-based approach to create an index to identify which census tracts were of greatest priority for cancer screening, thereby creating a priority scoring metric for deploying the MSU across our 7-county cancer center catchment area. Methods: We assessed publicly available data reported at the census tract level for cancer relevance, choosing those data that were most likely to be associated with disparities in cancer screening or outcomes. This included data from the Social Vulnerability Index (socioeconomic status, percent of residents without health insurance, percent of residents reporting minority race or ethnicity, percent renting their housing, and percent with no transportation) as well as data from the Centers for Disease Control and Prevention (CDC) Places on the percent screened for breast cancer, cervical cancer, and colon cancer. Data was transformed from CDC Places to be percentage in need of breast cancer, cervical cancer, and colon screening rather than percentage screened. To construct the index, each of the variables was ranked from highest to lowest across all census tracts in Pennsylvania and New Jersey with a non-zero population (n=1,184). A percentile rank was then calculated for each census tract over each of these variables. Finally, an overall percentile rank for each tract was calculated. Index scores could range from 0.000000 (low priority for cancer screening) to 1.000000 (high priority for cancer screening). Results: There are 1,184 census tracts within our cancer center catchment area. Gloucester County NJ has the fewest census tracts (n=63) while Philadelphia County PA has the most census tracts (n=384). The mean index score across all census tracts was 0.400593 (SD = .198556) with a range of 0.000000 to 0.938343. Philadelphia County had the highest mean index score (0.400953) while Bucks County PA had the lowest mean index score (0.281576). In Philadelphia County, 76% of census tracts are above the mean index score, indicating high need for cancer screening, while in Bucks County, only 22% of census tracts are above the mean index score. A catchment area map by census tract visualizes the index score across the counties. Conclusion: A cancer screening index for census tracts in a cancer center catchment area can be used to prioritize resources such as a MSU in an evidenced-based manner. Next steps involve validating the index score against cancer disparities data in our catchment area and creating disease specific index scores to use with cancer specific screening initiatives. Citation Format: Krista Mar, Yawei Song, Khaldoun Hamade, Maria Katerina Alfaro, Alex Wrem, Christopher McNair, Amy Leader. Identifying priority neighborhoods for mobile cancer screening using georeferenced data [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A017.

Osteoporosis Screening Disparities in The Inland Empire of Southern California

Introduction: Osteoporosis is a common disease with high morbidity and mortality for fragility fractures. Effective treatments can be initiated prior to the first fracture if osteoporosis is diagnosed by Dual Energy X-Ray screening (DXA). DXA screening is recommended in women aged 65 or older and in men aged 70 or older. Disparities exist in the rates of screening based on ethnicity and gender. The aim of this study was to determine if there are disparities in OSP screening on the basis of ethnicity, gender or primary language spoken. Methods: A retrospective chart review was performed utilizing the Slicer Dicer tool in Epic to determine the rate at which osteoporosis screening is documented as being performed. Demographic data such as gender, age, ethnicity and preferred language were recorded. Results: 93% of women aged 65 or greater were documented as being screened for osteoporosis. 40% of those screened and 52.3% of those not screened were white. 39.1% of women who were screened and 28% of those not screened were Hispanic. 97.4% of men aged greater than 70 years were not screened. The percentage of men screened who identify as Hispanic were lower than those who were not screened (26.3% vs 39.3%) and there were similarly differences in those who identify as White in men, 57.5% of those screened vs. 41.4% of those not screened. Language proficiency were the same in all groups (men and women, screened and not screened). Differences between ethnic groups were calculated using Chi-Square testing and were found to be not statistically significant. Conclusion: Women are documented as having been screened for osteoporosis at a far greater rate than men. In women, Hispanic, White and Black patients were screened at similar rates. Language proficiency did not change the likelihood of being screened for osteoporosis. There are fewer Hispanics in the age groups studied than expected for the general population of the counties.

Abstract A104: Partnering with primary care to implement evidence based interventions (EBI) to address overdue colorectal cancer (CRC) screening in Connecticut (CT)

Abstract PURPOSE: Partnering with the largest Federally Qualified Health Center (FQHC) in New Haven, CT, the goal is to implement and test 4 evidence-based interventions (EBI) to increase CRC screening, while evaluating real-world implementation. Here, we report on the six-month (approximate) follow up of a cohort of 3,127 patients overdue for CRC screening who received 1 or more EBIs in October 2021. BACKGROUND: Sociocultural and medical concerns are barriers to colonoscopy uptake contributing to disparities in CRC screening. An additional barrier is system level capacity. COVID-19 associated delays exacerbated the existing backlog of individuals overdue for CRC screening, underscoring the need to expand Fecal Immunochemical Testing (FIT) capacity. This was particularly evident in the safety-net primary care setting that serves lower socio-economic status individuals living in urban New Haven, CT. METHODS: We are testing the unique and additive value of multiple evidence-based interventions (EBIs) for increasing CRC screening. The EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and providing assistance from community health workers (CHW). We randomized 3,127 patients overdue for CRC screening to one of 4 arms of the study. All individuals received a reminder from their providers that they were due/overdue for CRC screening with instructions to contact the FQHC. Arm 2 also included information on SDOH barriers, Arm 3 included this same information with offer of navigation from CHW/navigator; and Arm 4 included the offer of CHW educational video and support if needed. Six-month (approximate) outcomes include: 1) Engagement with FQHC resulting in ordered test; 2) completed test. Results by intervention will be assessed at 12 months. RESULTS: Of the 3,127 randomized patients, ages 50-75, 77% were Hispanic (33%) or Black (44%). At 6+ months, a preliminary look at EMR data show that a minimum of 1,275 (40.8%) patients “engaged” with providers resulting in an ordered FIT Kit (n= 1174) or COMPLETED screening colonoscopy that was not associated with a positive FIT result (n = 102). 217 (18.5%) individuals completed the FIT testing with 13 requiring confirmatory colonoscopy (31% completed at this time). Thus, a minimum of 319 (10%) of 3,127 individuals in the cohort completed CRC screening at approximately 6 months post intervention. DISCUSSION: Despite investments in community engagement, stakeholder input, and FIT kit capacity building, the pandemic presented unforeseen challenges. Flexibility and steadfast commitment from FQHC providers and staff were critical to successful implementation during multiple waves of COVID-19, resulting in CRC screening ordered for 41% of cohort within 6 months of intervention. SUMMARY: At 6 months follow up of 3,127 individual who were overdue for CRC screening, one or more of 4 EBIs, in addition to system level efforts to address CRC screening, resulted CRC screening tests ordered for 41% of cohort with at least 10% completed screening. Citation Format: Beth A. Jones, Sakinah C. Suttiratana, Sarah A. DeGiovanni, Steven J. Parra, Levita Robinson, Michael Couturie, Louie Mar Gangcuangco, Denise Stevens. Partnering with primary care to implement evidence based interventions (EBI) to address overdue colorectal cancer (CRC) screening in Connecticut (CT) [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A104.

Abstract B055: Health literacy, health numeracy, and cancer screening patterns in the Zuni Pueblo: Insights from and limitations of “standard” questions

Abstract American Indians (AIs) experience disparities in cancer screening, stage at disease diagnoses, and 5-year cancer survival. This study investigates how health literacy and health numeracy may be linked to cancer screening behaviors of Zuni Pueblo members using a survey exploring cancer screening behaviors related to breast, cervical, and colorectal cancers. As part of a larger community-based cancer-prevention project, Zuni Health Initiative staff conducted surveys from October 2020 through April 2021 for a total of 280 participants (men ages 50-75 and women ages 21-75) from the Zuni community. The project is in collaboration with the Pueblo of Zuni and has received research approval from the Zuni Pueblo Tribal Council, the Southwest Tribal IRB, and UNM Health Sciences Center IRB. Bivariate and multivariable analyses investigated associations between health literacy/numeracy measures and cancer screening behaviors. Bivariate analyses showed some associations between distinct measures of health literacy/numeracy and colorectal cancer (CRC) screening, including both colonoscopy (health literacy) and fecal occult blood testing (FOBT) (health numeracy), as well as cervical cancer screening (health literacy). There were no statistically significant associations between health literacy/numeracy measures and mammogram screening for breast cancer. In multivariable analyses, there were no consistent patterns between health literacy/numeracy and screening for any cancer. There are some individual findings worth noting, such as statistically significant findings for health numeracy and FOBT (those reporting lower health numeracy were less likely to report FOBT). An important finding of this study is that questions used to assess health literacy/numeracy did not identify associations aligned with previous research. We reflect on the ways the “standard” questions may not be sufficiently tailored to the Zuni experience and may contribute to health equity barriers. Citation Format: Kate Cartwright, Samantha Leekity, Judith Sheche, Deborah Kanda, Mikaela Kosich, Madison Gonya, Nicholas Edwardson, V. Shane Pankratz, Shiraz I. Mishra. Health literacy, health numeracy, and cancer screening patterns in the Zuni Pueblo: Insights from and limitations of “standard” questions [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B055.

Prevalence of Kidney and Urinary Tract Complications in Fabry Disease from 2000 to 2020: A Global Cohort Study Including 10,637 Patients.

Fabry disease, an X-linked lysosomal storage disorder, causes progressive globotriaosylceramide accumulation in cells throughout the body. Characteristic multiorgan manifestations include renal dysfunction (Fabry nephropathy) and associated urinary tract complications. Enzyme replacement therapy (ERT) has been available since 2001, but contemporary real-world data are lacking regarding Fabry nephropathy risks and treatment outcomes. This retrospective cohort study analyzed electronic medical records data for 10,637 Fabry disease patients from the TriNetX research database. Kidney and urinary tract outcomes were evaluated over two decades, 2000-2010 and 2011-2020. Outcomes assessed included chronic kidney disease (CKD), urinary tract infections, urinary incontinence, obstruction, renal insufficiency, and end-stage renal disease (ESRD). The prevalence of stage 4-5 CKD nearly doubled between 2000-2010 and 2011-2020, while ESRD prevalence rose over 4-fold. Incidence rates showed similar marked elevations across renal and urologic complications. Females and Black patients experienced disproportionate escalations in kidney and urinary tract morbidity. This large cohort study revealed significantly increased Fabry nephropathy and associated urologic complications over the past two decades, contradicting expectations of reduced morbidity with ERT availability. The findings highlight needs to optimize screening, treatment strategies, monitoring practices, and address disparities to curb rising disease burden and improve patient outcomes.

A Scoping Literature Review on Evidence-Based Strategies to Increase Cervical Cancer Screening.

Previous reviews of strategies to increase cervical cancer screening are more than 10 years old, the U.S. continues to fall short of the Healthy People 2030 cervical cancer screening goal, and guidelines were revised in 2018, therefore an updated review of the existing literature is needed. We conducted a scoping review using electronic databases PubMed, Scopus, and Ovid Medline that included publication dates between 2012 and 2021 to answer the question, "Which strategies implemented in U.S. primary care settings have been most successful in increasing rates of cervical cancer screening since the 2012 US Preventative Services Task Force cervical cancer screening guidelines were published?" We mapped findings to pre-specified implementation strategy categories. After initially identifying 399 articles, we excluded 350 due to duplicates or not meeting review criteria, leaving 49 articles for full review. We excluded 37 of these during full-text review and identified 2 additional articles from the manual search of reference lists for a total of 14 studies for abstraction. Eleven articles reported on strategies resulting in increased cervical cancer screening, and 3 did not. Clinic workflow re-design strategies showed the greatest promise in improving cervical cancer screening rates, education strategies for patients had mixed results, and quality management strategies were not effective. These findings suggest clinical workflow re-structures and patient education strategies can increase cervical cancer screening in primary care settings. Results are particularly important in settings that care for underserved populations, as these settings may need additional implementation strategies to decrease cervical cancer screening disparities.

Culturally targeted message framing and colorectal cancer screening preferences among African Americans.

The current study investigated whether culturally targeted message frames alter preferences for specific colorectal cancer (CRC) screening modalities among African Americans. African Americans who were eligible for CRC screening (N = 457) viewed a video about CRC risks, prevention, and recommended screening options. Participants then received a gain or loss-framed message about screening, with half of participants viewing an additional culturally targeted message about overcoming disparities in CRC through screening. Participants reported their desired thoroughness in CRC screening and preferences for being screened using colonoscopy, sigmoidoscopy, or stool-based fecal immunochemical testing. Relative to gain-framing, loss-framed messaging enhanced desired thoroughness in CRC screening. Targeted loss-framing enhanced preferences for colonoscopy and decreased preferences for stool-based FIT screening. Findings demonstrate that message framing and culturally targeted messaging can impact CRC screening preferences. Altering preferences may carry implications for reducing CRC screening disparities among African Americans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Feasibility and anticipated acceptability of community health worker-facilitated HPV self-sampling for cervical cancer screening around Lake County, Indiana.

In light of calls to engage community health workers (CHWs) in the delivery of cervical cancer screening innovations, this study explores CHW perspectives on i) barriers to cervical cancer screening in a predominantly Hispanic community in Lake County, Indiana, the county with the highest cervical mortality in the state; and ii) the acceptability and feasibility of CHW-facilitated human papillomavirus (HPV) self-sampling as a means of reducing screening disparities. In 2021, in-depth interviews were conducted with 15 CHWs employed by Lake County community-based organizations including clinics, schools, and faith-based organizations. Harnessing CHWs' voices as insiders with knowledge of their communities' health landscape, our analysis identified multilevel barriers to screening that spanned individual, interpersonal, and community levels of the socio-ecological model. CHW-facilitated HPV self-sampling shows promise of mitigating several barriers to cervical cancer screening. Privacy, time saved, and comfort were perceived to be facilitators for acceptability, with concerns about the novelty of this approach and trust in provider (as opposed to CHW) expertise emerging as key barriers. In terms of feasibility, synergies with existing CHW work, and some community members' prior experience with self-sampling were found to be facilitators, while CHW's time limitations and self-efficacy in providing adequate medical support were areas of concern. Considerations for adoption included CHW training, gender concordance, safety, and respect, among others. This study provides critical insights from CHWs as key stakeholders on a screening model that directly engages them, which can inform implementation to increase screening in medically-underserved communities in the US.