ASPO Abstracts
Colorectal cancer screening adherence and racial/ethnic inequalities among the foreign-born associated with time living in the U.S.
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
Purpose of the study: Longer time lived in the US has often been associated with declining health outcomes
among foreign-born (FB) individuals, as characteristics of longer-term residents better resemble their US-
born than recently arrived FB counterparts. In this study, we evaluated the association between time lived in
the US and colorectal cancer (CRC) screening adherence, and whether this relationship differed by
race/ethnicity. Methods: We used data from the National Health Interview Survey for 2010, 2013, 2015 and
2018, the most recent years with available data. CRC screening adherence was defined according to
USPSTF guidelines (50-75y). People with CRC diagnosis were excluded. Time in the US was defined as:
US-born (reference), FB≥15y and FB<15y. Generalized linear models with Poisson distribution were used to
calculate adjusted prevalence ratios and 95% confidence intervals. Sequential analyses were conducted
adding demographics and survey year, socioeconomic information, healthcare variables, and US citizenship.
Analyses were also stratified by race/ethnicity and accounted for the complex sampling design. Results were
weighted to be representative of the US population. Results: A total of 44653 participants (US-born,
n=37787; FB≥15y, n=6003; FB<15y, n=834) were included in the study. Prevalence of CRC screening
adherence was 63% overall, 64% for US-born, 55% for FB≥15y and 35% for FB<15y. In minimally adjusted
models for all and among Hispanics and Asians, FB had lower adherence than US-born with FB<15y having
the lowest adherence. Among Hispanics, adjusting for citizenship fully attenuated results with no significant
differences between FB and US-born. Among Asians, some attenuation was observed in fully adjusted
models, but the pattern remained. Among NHW and NHB, only FB<15y had lower adherence; these patterns
remained in fully adjusted models with some attenuation. Conclusions: CRC screening adherence varied by
race/ethnicity. Among Hispanics, citizenship attenuated lower adherence in FB. Among Asians, NHB and
NHW, differences by time in the US remained in fully adjusted models, suggesting other factors may explain
them. Culturally and ethnically targeted interventions should consider these potential explanatory factors to
CRC screening adherence.
Keywords: colorectal cancer, screening, immigrants, disparities, race/ethnicity