Abstract A114: Association of racial residential segregation and screening uptake for cervical and colorectal cancer among Black and White patients in five diverse U.S. healthcare systems
Authors: Pruitt Sandi L. , Ibekwe Lynn N. , Todd Kaitlin , Breslau Erica S. , Burnett-Hartman Andrea N. , Clark Cheryl R. , Vecchio Natalie J. Del , Haas Jennifer S. , Honda Stacey , Li Christopher I. , Winer Rachel L. , Neslund-Dudas Christine , Issaka Rachel 
Published: January 2023

Abstract
Background Black people experience excess cervical and colorectal (CRC) cancer burden. Racial residential segregation, one measure of exposure to racism, is a potential driver of these inequities. To achieve cancer equity, it is crucial to better understand the role of racism and cancer prevention and early detection behaviors, including cancer screening. We assessed the association of exposure to Black residential segregation and cancer screening among Black and White adults. Methods This was a retrospective cohort study using electronic medical record data from patients who were members of the Population-based Research to Optimize the Screening Process (PROSPR) cohort. The sample included non-Hispanic (NH) Black or NH White average-risk urban adults at five U.S. healthcare settings who were eligible and due for cervical cancer screening (women aged 21-65 years) or CRC screening (50-75 years) when they had a primary care appointment (cohort entry) from 2010-2012. Black residential segregation was measured using sample-based quartiles of the local exposure and isolation (LEx/Is) metric comprising census-tract level data from 2008-2012 American Community Survey. The outcome was receipt of cervical cancer screening (completion of Pap or Pap/human papillomavirus [HPV] co-test) or CRC screening (completion of FIT/gFOBT, sigmoidoscopy, or colonoscopy) within 3 years of cohort entry. Multilevel logistic regression was used to calculate association of segregation and screening while adjusting for patient- and census-travel level covariates (age, race, sex, year of cohort entry, comorbidities, healthcare system, and census tract level poverty rate.) Results Of 164,238 and 652,719 patients eligible and due for cervical cancer or CRC screening respectively, 106,753 (65.0%) and 465,042 (71.2%) received timely screening. Black patients (6.4% of cervical screening and 15.7% of CRC screening sample), compared to White patients, were more likely to live in neighborhoods in the highest quartile of Black segregation (cervical sample: 44.1% vs. 17.6%; CRC sample: 51.8% vs. 19.4%). Greater exposure to segregation was associated with lower odds of cervical cancer screening (Quartile [Q]4 vs. Q1 odds ratio [OR]=0.92; 95% CI 0.89-0.94) and CRC screening (Q4 vs. Q1 OR=0.91; 95% CI 0.89-0.92) in unadjusted models; these associations were attenuated in adjusted models for cervical (Q4 vs. Q1 adjusted OR[aOR]=0.99; 95%CI=0.95-1.03) and CRC screening (Q4 vs. Q1 aOR=1.0; 95% CI 0.97-1.02). Notably, in adjusted models for both screening types, higher census tract level neighborhood poverty rate was associated with lower odds of screening, and Black (vs. White) race was associated with higher odds of cervical cancer screening but lower odds of CRC screening. Discussion In this study within five healthcare systems, Black residential segregation was not associated with screening after adjustment for other variables. Additional analyses will assess potential for effect measure modification by patient race, healthcare system, and other factors.
Citation Format: Sandi L. Pruitt, Lynn N. Ibekwe, Kaitlin Todd, Erica S. Breslau, Andrea N. Burnett-Hartman, Cheryl R. Clark, Natalie J. Del Vecchio, Jennifer S. Haas, Stacey Honda, Christopher I. Li, Rachel L. Winer, Christine Neslund-Dudas, Rachel Issaka. Association of racial residential segregation and screening uptake for cervical and colorectal cancer among Black and White patients in five diverse U.S. healthcare systems [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 A114.