Abstract B68: Assessing screening disparities for CRC by race across states
Authors: Cooper Rachel , Cohen Noah , Schofield Elizabeth , Starr Tatiana , Nelson Chris , Jandorf Lina , Duhamel Katherine 
Published: May 2016

Background: Recent research suggests that there are geographic “hotspots” in the United States which have higher colorectal cancer (CRC) mortality rates [1]. These regions are characterized by high poverty, wherein individuals with lower socioeconomic status are less likely to undergo CRC screening tests, leading to a later stage of diagnosis and increased risk of mortality [1]. Additionally, significant racial disparities have been identified regarding CRC screening rates, although not always consistent, with the lowest rates amongst Blacks [2]. Furthermore, Hispanics over age 50 (the recommended age to begin screening at risk individuals) are less likely to have had a recent CRC screening than non-Hispanic Whites (29.9 vs. 44.3%) [3]. This study aims to identify geographic and racial disparities for CRC screening rates within the U.S. so that future interventions can be targeted according to geographic location and population demographics.

Method: Analysis was conducted using available data published through the Behavioral Risk Factor Surveillance System (BRFSS) on the Centers for Disease Control and Prevention (CDC) website. The data were published on the “BRFSS: Table of Colorectal Cancer Screening,” and were open and available to the public [4]. While we recognize that these data were already published, we have analyzed it in a novel way, allowing us to formulate new research. Visual maps showing the ratios of screening rates for both fecal occult blood tests (FOBT) and colonoscopies were generated using SAS software. Additional maps were also created to display the overall screening rates for both screening tests according to race by state. Based on previous literature, states with screening data were grouped into five geographic regions: Northeast, Southeast, Midwest, West, and Southwest [5]. After data were weighted by population for each state, average screening rates were found for each race by test type and region. Ratios of Black to White and Hispanic to White screening rates for each test by region were also calculated in order to better understand the current disparities between the races by geographic location.

Results: The lowest overall screening rates were found within the Hispanic population in the Southwest (10% for FOBT, 47% colonoscopy). The highest rates were within the White population in the Southeast (17% FOBT, 70% colonoscopy). The largest racial disparities were found between Hispanics and Whites in the West (ratio of 0.72 FOBT, 0.68 colonoscopy) and Southwest (ratio of 0.75 FOBT, 0.69 colonoscopy). Overall, Blacks had higher rates of FOBT screenings than Whites, with the largest disparity found in the Southwest (ratio of 1.57); colonoscopy rates were generally lower than Whites, with the largest disparity found in the Midwest (ratio of .91). Screening rates were most similar between Blacks and Whites in the Northeast (ratio of 1.20 FOBT, 0.98 colonoscopy).

Conclusion: Future interventions should be targeted at increasing CRC screening rates for Hispanics, particularly in the West and Southwest regions of the U.S. Four of the states in these regions (New Mexico, Alaska, Texas, and Oklahoma) rank in the top ten states with the highest poverty levels [6]. Six states in these regions (Texas, Nevada, Arizona, Wyoming, New Mexico, and Alaska) are also in the top ten for the greatest percentage of the population without health insurance [7]. Due to these high poverty levels and subsequent lack of health insurance, individuals experience more obstacles to accessing benefits of healthcare such as CRC screening.

Citation Format: Rachel Cooper, Noah Cohen, Elizabeth Schofield, Tatiana Starr, Chris Nelson, Lina Jandorf, Katherine Duhamel. Assessing screening disparities for CRC by race across states. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B68.