Abstract B137: Association of housing, transportation, and food insecurity with early adoption of colorectal cancer screening among adults aged 45-49 after the 2021 USPSTF recommendation update
Authors: Chen Katherine L. , Mangione Carol M. , Tina Shih Ya-Chin 
Published: September 2024

Background: In 2021, the United States Preventive Services Task Force (USPSTF) lowered the recommended starting age for colorectal cancer (CRC) screening for average-risk individuals from 50 to 45, but little is known about the characteristics of newly eligible individuals (aged 45-49) who have begun screening. In general, uptake of new medical technologies tends to be delayed in socioeconomically marginalized populations due to issues of access, cost, and awareness. Recent literature has implicated unmet social needs, including housing, transportation, and food insecurity, as barriers to health care access that may contribute to reduced likelihood of cancer screening by producing competing demands on patients’ finances, time, and stress. We sought to evaluate the association between unmet social needs and CRC screening among adults newly eligible for screening following the recent USPSTF recommendation change. Methods: We analyzed data on US adults aged 45-49 with no personal history of cancer in the 2022 Behavioral Risk Factor Surveillance System. The primary outcome was self-reported receipt of a CRC screening test (colonoscopy, sigmoidoscopy, or stool test) in the past 2 years. Our primary predictors were 3 dichotomous variables indicating unmet social needs (housing, transportation, or food insecurity) in the past 12 months and the total count of unmet social needs. We ran separate weighted logistic regression models testing associations between each predictor and CRC screening, adjusting for age, sex, race/ethnicity, education, income, employment, homeownership, marital status, household with children, insurance status, self-rated health status, number of chronic conditions, urbanicity, and state. Results: A total of 15,561 adults aged 45-49 were included (50% female; 20% Hispanic; 6% Asian, 14% Black, 56% White, 5% other non-Hispanic; 80% employed; 90% insured). Overall, 14%, 7%, and 13% reported recent insecurity in housing, transportation, and food; 19% reported any CRC screening in the past 2 years. In adjusted models, housing insecurity was associated with a 4.4 percentage-point (pp) reduction (95% CI: -8.0, -0.7) in probability of CRC screening compared to those without housing insecurity. Transportation and food insecurity were not independently associated with CRC screening (absolute difference in CRC screening rate: -1.7pp [95% CI: -6.5, 3.1] and -3.7pp [-7.8, 0.5], respectively), but each additional need in the total count of unmet social needs was associated with a 2.6-pp reduction in CRC screening (95% CI: -4.7, -0.5). Conclusions: Among adults aged 45-49, those who experienced housing insecurity were less likely to be early adopters of the new CRC screening guidelines, and screening rates decreased as people experienced more social barriers. Interventions that mitigate social needs, especially housing insecurity, might increase timely CRC screening in socially vulnerable populations, thus enhancing equity in CRC outcomes.

Citation Format: Katherine L. Chen, Carol M. Mangione, Ya-Chin Tina Shih. Association of housing, transportation, and food insecurity with early adoption of colorectal cancer screening among adults aged 45-49 after the 2021 USPSTF recommendation update [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B137.