Odds Of Colorectal Cancer Screening Research Articles

The Association Between Religiosity, Spirituality and Colorectal Cancer Screening: A Longitudinal Analysis of Alberta's Tomorrow Project in Canada.

We explored longitudinal associations between religion/spirituality (R/S) Salience and R/S Attendance, and colorectal cancer screening, among adults aged≥ 50 yearsin Alberta, Canada. R/S Salience was not statistically significantly associated with colorectal cancer screening (adjusted odds ratio [aOR]: 1.06, 95% confidence interval [CI] 0.88-1.28). Conversely, R/S Attendance was statistically significantly associated with higher odds of colorectal cancer screening: the aOR was 1.28 (95% CI 1.02-1.59) for participants attending services at least once a month and 1.31 (95% CI 1.01-1.69) for participants attending between one and four times yearly, compared to participants who never attended. Researchers should explore the possibility of delivering colorectal cancer screening programs in R/S settings.

Colorectal Cancer Screening Receipt Does Not Differ by 10-Year Mortality Risk Among Older Adults.

Health status and life expectancy are important considerations for assessing potential benefits and harms of colorectal cancer (CRC) screening programs, particularly among older adults. We examined receipt of past-year CRC screening according to predicted 10-year mortality risk among 25,888 community-dwelling adults aged 65-84 years who were not up-to-date with screening in the nationwide National Health Interview Survey. Ten-year mortality risk was estimated using a validated index; from the lowest to highest quintiles of the index, risk was 12%, 24%, 39%, 58%, and 79%, respectively. We also examined the proportion of screening performed among adults with life expectancy <10 years. The prevalence of past-year CRC screening was 39.5%, 40.6%, 38.7%, 36.4%, and 35.4%, from the lowest to highest quintile of 10-year mortality risk. Odds of CRC screening did not differ between adults in the lowest vs highest quintile (adjusted odds ratio 1.05, 95% confidence interval: 0.93-1.20). One-quarter (27.9%) of past-year CRC screening occurred in adults with life expectancy <10 years, and more than half (50.7%) of adults aged 75-84 years had 10-year mortality risk ≥50% at the time of screening. In an exploratory analysis, invasive but not noninvasive screening increased as 10-year mortality risk increased ( P < 0.05) among adults aged 70-79 years. Past-year CRC screening does not differ by predicted 10-year mortality risk. An age-based approach to CRC screening results in underscreening of older, healthier adults and overscreening of younger adults with chronic conditions. Personalized screening with incorporation of individual life expectancy may increase the value of CRC screening programs.

Prevalence and predictors of colorectal cancer screening in the United States: evidence from the HINTS database 2018 to 2020.

The incidence of colorectal cancer (CRC) and CRC-related mortality among young adults (< 50years) has been on the rise. The American Cancer Society (ACS) reduced the CRC screening age to 45 in 2018. Few studies have examined the barriers to CRC screening among young adults. Analyses were conducted using data from 7,505 adults aged 45-75years who completed the 2018 to 2020 Health Information National Trends Survey. We examined the sociodemographic characteristics associated with CRC screening overall and by age group using separate multivariable logistic regression models. 76% of eligible adults had received screening for CRC. Increasing age, Black racial group [OR 1.45; 95% CI (1.07, 1.97)], having some college experience, a college degree or higher [OR 1.69; 95% CI (1.24, 2.29)], health insurance coverage [OR 4.48; 95% CI (2.96, 6.76)], primary care provider access [OR 2.48; 95% CI (1.91, 3.22)] and presence of a comorbid illness [OR 1.39; 95% CI (1.12, 1.73)] were independent predictors of CRC screening. Current smokers were less likely to undergo CRC screening [OR 0.59; 95% CI (0.40, 0.87)]. Among adults aged 50-64years, being of Hispanic origin [OR 0.60; 95% CI (0.39, 0.92)] was associated with a lower likelihood of CRC screening. CRC screening rates among adults 45-49years are low but are increasing steadily. Odds of CRC screening among Blacks is high which is encouraging while the odds among current smokers is low and concerning given their increased risk of developing CRC.

Disparities in the use of colorectal cancer screening in a universally insured population during the COVID-19 pandemic.

Despite the known efficacy of colorectal cancer (CRC) screening, the rates of individuals undergoing such testing have remained lower than target thresholds, even prior to the healthcare disruptions associated with the COVID-19 pandemic. We evaluated the impact of the COVID-19 pandemic on CRC screening within a nationally representative US population and assessed disparities in screening across racial/ethnic groups and socioeconomic (SES) strata. We performed a retrospective cross-sectional study using all eligible TRICARE beneficiaries aged 45-64 years between FY 2018 and 2021. High-risk individuals, those with a previous or current CRC diagnosis, and/or a personal/family history of colonic polyps, were excluded. The pre-COVID-19 period (September 1, 2018-March 31, 2020) was compared to the COVID-19 period (April 1, 2020-September 30, 2021). Secondary analyses were performed, evaluating the interaction between the COVID-19 time period, race, and our proxy for socioeconomic status. During the study period, we identified 1,749,688 eligible individuals. Following the onset of the COVID-19 pandemic, CRC screening overall decreased from 34% in the pre-pandemic period to 30% following the onset of the pandemic (p < 0.001). This finding persisted even after adjusting for confounders in multivariable analysis (odds ratio [OR] for the pandemic timeframe: 0.79; 95% CI: 0.27, 0.31; p < 0.001). In the setting of SES, in the pandemic period, the odds of individuals from both Senior Enlisted (OR: 0.55; 95% CI: 0.54, 0.56) and Junior Enlisted sponsor ranks (OR: 0.27; 95% CI: 0.25, 0.30) were diminished as compared to Senior Officers. We found a 21% reduction in the odds of CRC screening in the context of the COVID-19 pandemic. Reductions in colonoscopies and other types of screening tests were not offset by changes in the use of at-home tests such as Cologuard.

Abstract PO-166: The effects of neighborhood ethnic density and psychosocial factors on colorectal cancer screening behavior among Asian American adults

Abstract Introduction: This study examined how neighborhood ethnic composition influences colorectal cancer (CRC) screening behavior in Asian Americans and explored whether the associations between psychosocial predictors including knowledge, self-efficacy, and barriers with CRC screening behavior varied by the level of neighborhood ethnic composition. Methods: A total of 1,057 Filipino, Korean, and Vietnamese Americans aged 50 and older were included in the study. Psychosocial factors associated with CRC screening, CRC screening behavior, and socio-demographics were extracted from participants’ survey data. Neighborhood ethnic composition was characterized as the census-tract level percentage of Asian residents. Participant’s addresses were geocoded to the census tract level to determine whether they resided in an ethnically dense neighborhood. Results: The mixed-effects logistic regression model 1 illustrated that residing in an ethnically dense neighborhood was associated with lower odds of CRC screening (OR=0.65, 95% CI=0.49, 0.77; p=0.019) after controlling for age, gender, education, and ethnic group. Furthermore, greater perceived barriers to CRC screening (OR= 0.62; 95% CI=0.55, 0.90; p&amp;lt;0.001) resulted in a lower odds of obtaining a CRC screening, while higher self-efficacy (OR=1.17, 95% CI=1.11, 1.23, p&amp;lt;0.001) was associated with greater odds of CRC screening. In model 2, among those residing in a high ethnically dense neighborhood, greater barriers to screening was associated with lower odds of having obtained a CRC screening (OR=0.51; 95% CI=0.28, 0.93; p=0.028). Conclusion: The study findings revealed that residing in an ethnically dense neighborhood led to a lower likelihood of having obtained a CRC screening. Future studies should examine disparities in built environment, socioeconomic, and cultural factors that are characteristic of ethnically dense neighborhoods and their impact on CRC screening participation. Citation Format: Aisha Bhimla, Ming-Chin Yeh, Tyrell Mann-Barnes, Phuong Do, Chul Kim, Hemi Park, Grace X. Ma. The effects of neighborhood ethnic density and psychosocial factors on colorectal cancer screening behavior among Asian American adults [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-166.

Use of Colorectal Cancer Screening Among People With Mobility Disability.

We aimed to assess use of colorectal cancer screening (CRCS) as per United States Preventive Task Force guidelines among people with mobility disability using a nationally representative data set. Individuals with mobility disability have decreased access to health care services, but the impact of mobility disability on CRCS has not been investigated. Data from the 2013 National Health Interview Survey were used to estimate sociodemographic characteristics of adults with mobility disability, prevalence of CRCS, and odds of CRCS given mobility disability among Americans aged 50 to 75. In total, 56.8% of the entire sample (n=81,953,585) were up-to-date with CRCS. Mobility disability was not associated with CRCS status on univariable analysis but was significantly associated after adjustment for covariates including age and comorbidities, with an inverse relationship between the degree of mobility disability and odds of CRCS. Odds ratio for CRCS given progressively severe disability were 0.78 (0.66 to 0.93), 0.71 (0.53 to 0.94), 0.65 (0.31 to 1.19). The present study indicates reduced CRCS among people with mobility disability and highlights the need for CRCS to be especially targeted toward this group. Future research should identify the specific systemic, social, and/or physical barriers to CRCS for this subgroup so that they can be addressed.

Abstract B70: Exploring the role of acculturation in breast, colorectal and cervical cancer screening among Hispanic women

Abstract Racial and ethnic disparities exist in cancer screening and management among Hispanics. Although cancer poses a burden among Hispanic women compared to non-Hispanic white women (nHw), screening rates for breast, colorectal and cervical cancer in Hispanic women lag behind nHw. The Hispanic population is heterogeneous and comprises individuals with diverse heritages. Furthermore, considerable variations in health outcomes and practices have been observed across Hispanic subgroups, supporting the relevance of studying each subgroup separately. Since early detection can reduce the burden of cancer, it is important to identify factors that can predict cancer screening within subgroups of Hispanic women. We sought to assess the role of acculturation in adherence to recommended cancer screening practices among Hispanic postmenopausal women, and to assess whether this association varies by Hispanic subgroup using data from the Women's Health Initiative. We included women who identified themselves as Hispanic in the baseline questionnaire (N=3, 263). All women who reported a personal history of cancer other than non-melanoma skin cancer were excluded from the study. Only women without a hysterectomy were included in the cervical cancer screening analysis (N=1,754). Acculturation was measured using self-reported country of birth, language preference and length of residency in the United States (US). Cancer screening adherence was assessed based on the American Cancer Society guidelines in place at the beginning of the study in 1993. The study outcomes were self-reported breast cancer screening (mammography use) and cervical cancer screening (Pap smear use) during the past year and colorectal cancer screening (sigmoidoscopy or colonoscopy use) within five years prior to the interview. Logistic regression was used to estimate the prevalence odds ratio for three types of cancer screening (breast, cervical and colorectal) according to the acculturation level among Hispanic women and within subgroups (Cuban (N=137), Mexican (N=1,151), Puerto Rican (N=289) and Other Hispanic (N=693)), with adjustment for age, alcohol use, family history of cancer, body mass index, physical activity level, and smoking status. Prevalence of breast, colorectal and cervical cancer screening was 68.7%, 55.9% and 47.1%, respectively. Highly acculturated women (US-born, English language preference and living in the US longer than in their country of origin) were more likely to be screened for breast (OR=2.12; 95% CI: 1.57-2.86), cervical (OR=1.46; 95% CI: 0.98-2.18) and colorectal cancer (OR=4.61; 95% CI: 3.27-6.50) within guidelines compared to Hispanic women with low acculturation level. Adjusting for socioeconomic factors attenuated the strength of these associations. For receipt of mammogram, subgroup analysis showed that acculturation mattered in the receipt of a mammogram only for Mexican/Mexican American women (OR=1.35; 95% CI: 1.01-1.82) for high vs. moderate/low acculturation. High acculturation was associated with greater adjusted odds of colorectal cancer screening among Mexican/Mexican American (OR=1.46; 95% CI: 1.10-1.95), Cuban women (OR=18.17; 95% CI: 2.17-152.37), and women from other Hispanic origins (OR=1.50; 95% CI: 1.07-2.11) when compared to women from their same national origin with a moderate/low acculturation level. No significant association between acculturation and cervical cancer screening were observed within the subgroups. These data show important differences in the impact of acculturation on cancer screening uptake among subgroups of Hispanic women. These findings will be useful to develop educational programs, and culturally tailored strategies for each Hispanic subgroup with the end goal of reducing the observed racial and ethnic disparities existent in cancer and promoting colorectal and breast cancer screening. Citation Format: Mary Vanellys Diaz-Santana, Susan Hankinson, Susan Sturgeon, Carol Bigelow, Milagros Rosal, Judith Ockene, Katherine W. Reeves. Exploring the role of acculturation in breast, colorectal and cervical cancer screening among Hispanic women. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B70.

Physician Participation in Meaningful Use and Quality of Care for Medicare Fee-for-Service Enrollees.

The Meaningful Use initiative has made nearly $30 billion available through incentive programs to encourage provider adoption and use of electronic health records. The objective of this study was to evaluate the impact of outpatient physicians' participation in Meaningful Use on the quality of care provided to Medicare fee-for-service (FFS) enrollees. Retrospective cohort study. One hundred percent inpatient and outpatient Medicare FFS claims covering the period January 2010 through December 2012. 303,110 Medicare FFS enrollees from New York State. Hospitalizations and emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs), diabetic retinopathy screening, diabetic nephropathy screening, colorectal cancer screening, and influenza vaccinations. Physician participation in the Meaningful Use initiative was not associated with reductions in ACSC-related hospitalizations (0.0 percentage points, 95% confidence interval (CI): 0.0-0.1) or ED visits (0.0 percentage points, 95% CI: 0.0-0.1) relative to the comparison group. Meaningful Use participation was associated with higher odds of colorectal cancer screening (odds ratio (OR): 1.2, 95% CI: 1.1-1.4) relative to the comparison group, but not for diabetic retinopathy screening (OR: 1.1, 95% CI: 1.0-1.2), diabetic nephropathy screening (OR: 1.0, 95% CI: 0.8-1.2), or influenza vaccinations (OR: 1.1, 95% CI: 1.0-1.2). Similar results were found in secondary analyses of dually-eligible beneficiaries participating in both Medicare and Medicaid. Physician participation in Meaningful Use was not associated with substantial improvements on six quality measures.

PHS130 - Understanding The Underutilization Of Colorectal Cancer Screening Using The 2009-2011 Medical Expenditure Panel Survey (Meps)

Colorectal cancer is the third most frequently diagnosed cancer in the United States adult population with a projected mortality of more than 50,000 people in 2013. The purpose of this study was to examine patient, physician, and access-to-care factors that may influence the utilization of timely screening for colorectal cancer among US adults aged 50 years and above. The data source for this study was the 2009-2011 Medical Expenditure Panel Survey (MEPS). A multivariate binary logistic regression was used to examine the association between the predictor variables (patient demographics, physician attributes, and access-to-care characteristics) and the outcome variable (colorectal screening) for individuals in group I (50-75 years of age) as well as in group II (>75 years of age). Data were analyzed using SAS version 9.3. A total of 11,370 respondents, 50 years and above, were eligible for colorectal cancer screening as stated by the guidelines. Of these, 65% (n=7393) were adherent to recommended colorectal cancer screening guidelines. For group I, the regression analysis showed that the odds of undergoing colorectal cancer screening are significantly higher with increasing age, education, and family income, living in an urban area, and availability of health insurance and self-transportation to health services locations. Similarly for group II, the regression analysis revealed that the odds of colorectal cancer screening were higher with increasing family income and availability of self-transportation. Conversely, the odds of screening were lower in individuals with good to excellent health status for groups I and II. Developing policies and programs to educate and promote awareness in rural areas, low-income groups, among those with better health conditions, and in those seeking primary care treatment could improve the colorectal cancer screening rate.

Preventive cancer screening practices in HIV-positive patients

As patients with HIV age, they are at risk of developing non-AIDS defining malignancies. We performed a questionnaire study to evaluate colorectal and breast cancer screening among HIV-positive and HIV-negative patients seeking care from either an integrated (HIV/primary care), nonintegrated (specialized HIV), or general internal medicine clinic between August 2010 and July 2011. We performed a logistic regression to determine the odds of cancer screening. A total of 813 surveys were collected, and 762 were included in the analysis. As much as 401 were from HIV-positive patients. Patients with HIV were less likely to be current with their colorectal cancer screening (CRCS) (54.4% versus 65.0%, p=0.009); mammography rates were 24.3% versus 62.3% if done during the past year (p<0.001), and 42.0% versus 86.7% if done during the past 5 years (p<0.001). In adjusted models, the odds of colorectal cancer screening in HIV-positive patients compared to negative controls was not statistically significant (OR 0.8; 95% CI 0.5–1.3); however, HIV-positive women remained significantly less likely to be current with breast cancer screening (BCS) whether their mammogram was completed within 1 year (OR 0.1, 95% CI 0.1–0.2) or within 5 years (OR 0.1, 95% CI 0.0–0.2). Integrated care was not associated with improved screening; however, having frequent visits to a primary care physician (PCP) increased the likelihood of getting screened. BCS was lower in HIV-positive compared to HIV-negative women. Frequent visits to a PCPs improved cancer screening.

Obesity Status and Colorectal Cancer Screening in the United States

Background. Findings from previous studies on an association between obesity and colorectal cancer (CRC) screening are inconsistent and very few studies have utilized national level databases in the United States (US). Methods. A cross-sectional study was conducted using data from the 2005 Medicare Current Beneficiary Survey to describe CRC screening rate by obesity status. Results. Of a 15,769 Medicare beneficiaries sample aged 50 years and older reflecting 39 million Medicare beneficiaries in the United States, 25% were classified as obese, consisting of 22.4% “obese” (30 ≤ body mass index (BMI) < 35) and 3.1% “morbidly obese” (BMI ≥ 35) beneficiaries. Almost 38% of the beneficiaries had a body mass index level equivalent to overweight (25 ≤ BMI < 30). Of the study population, 65.3% reported having CRC screening (fecal occult blood testing or colonoscopy). Medicare beneficiaries classified as “obese” had greater odds of CRC screening compared to “nonobese” beneficiaries after controlling for other covariates (ORadj = 1.25; 95% CI: 1.12–1.39). Conclusions. Findings indicate that obesity was not a barrier but rather an assisting factor to CRC screening among Medicare beneficiaries. Future studies are needed to evaluate physicians' ordering of screening tests compared to screening claims among Medicare beneficiaries to better understand patterns of patients' and doctors' adherence to national CRC screening guidelines.

Cancer Screening among Racial/Ethnic and Insurance Groups in the United States: A Comparison of Disparities in 2000 and 2008

Using the National Health Interview Survey, we examined associations among race/ ethnicity, insurance coverage, and cancer screening, and assessed changes in the magnitude of disparities over the past decade. Outcomes included recent cervical, breast, and colorectal cancer screening. Rates of colorectal screening increased for all racial/ethnic groups and some insurance groups from 2000 to 2008. However, rates of Pap tests and mammograms remained stagnant, and even decreased for certain groups. Some Hispanic-White and Asian-White disparities in cancer screening were reduced or eliminated over this time period. However, in 2008 Asians continued to have lower odds of Pap tests and Hispanics lower odds of colorectal cancer screening, even after accounting for potential confounders. There were no significant changes in Black-White disparities. The uninsured continued to be at a disadvantage for all three types of cancer screening, relative to the privately insured, as were publicly insured individuals with respect to colorectal cancer screening.

Causes of suboptimal colorectal cancer screening (CRCS) in U.S. immigrants.

380 Background: Research shows that CRCS in U.S. immigrants is low, but causes for this poor uptake are unclear. Our aims were to 1) compare CRCS among U.S. born citizens (USB), naturalized citizens (NAC) and non-citizens (NOC), 2) evaluate clinical factors associated with CRCS, and 3) explore health system barriers to CRCS for immigrants. Methods: Screening eligible patients were identified from the 2007 California Health Interview Survey. CRCS was defined as a fecal occult blood test within 1 year, a sigmoidoscopy within 5 years or a colonoscopy within 10 years. Using logistic regression, we determined the effect of immigrant status and other clinical factors on CRCS. We devised a 3-point composite scoring system based on survey responses to questions about health system barriers (where 0=worst and 3=best). Stratified analyses based on residence (urban vs rural), healthcare coverage (insured vs uninsured), English proficiency (good vs. poor), and composite score were conducted to assess their relationship with CRCS. Results: We identified 30,434 respondents: USB 83%, NAC 13%, NOC 4%; mean age 66, 65, 61 years; male 39%, 41%, 48%; white 85%, 38%, 29%, respectively. Only 67% of USB, 61% of NAC and 46% of NOC underwent CRCS (p&lt;0.001). Old age, male, high income earners, non-smokers, being married and those who visited their physicians frequently were more likely to receive CRCS (all p&lt;0.05). When compared to USB, NAC and NOC were associated with decreased odds of CRCS (OR 0.88, 95%CI 0.73-1.05 and OR 0.67, 95%CI 0.52-0.87, respectively; global p=0.009). Stratified analyses revealed that the association between immigrants and decreased CRCS was more evident for immigrants who lived in rural areas, lacked insurance, or those who were not proficient in English (Table). Immigrants with a composite score ≤2 also reported worse CRCS. Conclusions: CRCS remains suboptimal, especially in new U.S. immigrants. Inferior healthcare access and language barriers are potential drivers of this disparity. Addressing these system issues for immigrants may promote CRCS in this population. [Table: see text] No significant financial relationships to disclose.

The impact of Asian race on colorectal cancer screening (CRCS).

381 Background: While research shows that African Americans and Hispanics frequently receive less CRCS than Whites, few studies have focused on CRCS among Asians. The aims of the current analysis were to 1) compare CRCS between Asians and Whites in a large U.S. population, 2) evaluate for other clinical predictors of CRCS, and 3) examine the impact of health insurance coverage, place of birth and English proficiency on potential racial disparities. Methods: From the 2007 California Health Interview Survey, we identified all Asian (N=2,108) and White (N=23,237) average-risk respondents aged ≥50 years who were eligible for CRCS. Logistic regression was performed to evaluate for differences in CRCS between Asians and Whites. We used stratified and interaction analyses to examine whether associations between race and CRCS were modified by insurance status (insured vs uninsured), birthplace (U.S. vs non-U.S.) or language skills (good vs poor English), while controlling for other confounders. Results: Baseline characteristics were similar between Asians and Whites: mean age was 64 years in both groups; 45% and 47% were male; and 47% and 50% were employed, respectively. Only 58% of Asians and 66% of Whites reported undergoing up-to-date CRCS (p&lt;0.001). In multivariate analyses, female gender and those living in rural areas were less likely to receive CRCS (OR 0.84, 95%CI 0.76-0.93, p=0.001 and OR 0.88, 95%CI 0.81-0.98, p=0.015, respectively).When compared to Whites, Asians also had decreased odds of CRCS (OR 0.82, 95%CI 0.71-0.95, p=0.008), even after adjusting for confounders such as education and income. Stratified analyses revealed that this disparity existed mainly in the insured (OR 0.83, 95%CI 0.72-0.96, p=0.014), but not in the uninsured (OR 0.94, 95%CI 0.43-2.06, p=0.873). The relationship between race and CRCS was not modified by place of birth or English proficiency. Conclusions: Despite its ability to reduce mortality, CRCS is suboptimal in our U.S. population-based cohort of Asians when compared to Whites. The racial disparity was more evident within the insured subset, suggesting that factors unrelated to healthcare access, such as patient preference, physician discretion or patient-physician rapport, may be more important drivers of CRCS among Asians. No significant financial relationships to disclose.