Abstract C123: Racial and ethnic disparities in colorectal cancer screening utilization among adults with multiple chronic conditions: BRFSS 2012-2020
Authors: Oyinbo Atinuke G. , Castaneda-Avila Maira A. , Tisminetzky Mayra , Lapane Kate 
Published: December 2023

Abstract
Introduction: Colorectal cancer (CRC) screening utilization remains suboptimal in the U.S. despite national guidelines, and disparities are evident across different racial and ethnic groups. Language barriers further pose significant obstacles to CRC screening in racial/ethnic minority populations. Individuals with multiple chronic conditions (MCC) are at higher risk of developing CRC, thus screening is vital in this high-risk population to improve CRC outcomes and the management of other chronic conditions. This study examines racial/ethnic and language differences in CRC screening utilization among individuals with varying numbers of MCC. Methods: Participants aged 50-75 years from the U.S. Behavioral Risk Factor Surveillance System (2012-2020) were included (n=989,830). Counts of nine conditions available in the BRFSS (asthma, diabetes, cancer, non-melanoma skin cancer, cardiovascular disease, chronic obstructive pulmonary disease, arthritis, depression, and kidney disease), were categorized as none, 1, 2, 3, and ≥4 based on sample distribution. Self-reported CRC screening status was classified as up-to-date or not based on screening recommendations. Race/ethnicity groups included Hispanics completing the interview in Spanish as a limited English proficiency proxy (Hispanics with LEP), Hispanics without LEP, non-Hispanic Blacks (NHB), and non-Hispanic Whites (NHW). Adjusted prevalence ratios (aPRs) were estimated to evaluate the association between race/ethnicity and CRC screening among different counts of MCC using Poisson models. Models were adjusted for age, sex, health insurance, and survey year, and all findings were weighted to be representative of the broader US adult population aged 50-75 years. Results: Overall, 68.1% were aged 50 to 65 years, 52.2% were women, 76.4% were NHW and 66.5% were up-to-date with CRC screening. About one in seven had ≥4 MCC. Arthritis was the most common chronic condition among NHW, NHB, and Hispanics without LEP, while diabetes was the most common among Hispanics with LEP. Important differences were found in the association between being up-to-date with CRC screening and number of MCC across the different race/ethnicity subgroups. Higher proportions of Hispanic with LEP participants were not up-to-date with CRC screening compared to all other racial/ethnic groups. Hispanics with LEP had lower rates of up-to-date CRC screening across all MCC subgroups as compared to NHW (aPRno MCC: 0.67; 95% Confidence Interval (CI): 0.64-0.71; aPR≥4 MCC: 0.85; 95% CI: 0.79-0.91). Hispanics without LEP with 0, 1, or 2 MCC were less likely to be up-to-date for CRC screening compared to NHW. No statistically significant differences were found between NHB and NHW individuals. Conclusion: We found disparities among Hispanic with LEP, who had lower rates of up-to-date CRC screening compared to NHW, regardless of the number of MCC. Targeted interventions are needed to address these disparities and improve screening rates, particularly among Hispanics and with consideration for cultural and language barriers to CRC screening.
Citation Format: Atinuke G. Oyinbo, Maira A. Castaneda-Avila, Mayra Tisminetzky, Kate Lapane. Racial and ethnic disparities in colorectal cancer screening utilization among adults with multiple chronic conditions: BRFSS 2012-2020 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C123.