ASPO Abstracts
Racialized economic segregation and colorectal cancer screening in the United States, 2010-2018
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose of the study: To evaluate the association between residential segregation and adherence to colorectal cancer (CRC) screening. Methods: For adults 50- 75 years, National Health Interview Survey data (2010- 2018) were used to ascertain CRC screening adherence according to USPSTF recommendations. Residential segregation was operationalized using the Index of Concentration at the Extremes (ICE), based on income, race and ethnicity information obtained from the 2014-2018 American Community Survey estimates for counties. Four ICE versions were evaluated and consisted of the difference between households with White individuals reporting incomes in the highest quintile of the US distribution, and varying specifications of households with minoritized racial and ethnic individuals (all non-White–people of color [POC], Black, Latino, or Asian American/Pacific Islander) reporting incomes in the lowest quintile, divided by the total of households in the county. Each ICE was subdivided into quintiles (Q1-least advantaged, Q5-most advantaged). Logistic regression models with robust variance estimators accounting for within-county correlation were used. Models were adjusted for age, sex, race, ethnicity, nativity, marital status, SES and year of interview. Analyses were also stratified by race and ethnicity and weighted to represent the US population. Results: A total of 44,690 individuals were included, representing 38,192,958 people. In adjusted analyses for ICE POC, individuals residing in less advantaged counties had significantly lower adherence to screening guidelines than those residing in more advantaged counties (OR [95% CI], Q1: 0.78 [0.70-0.87], Q2: 0.76 [0.69-0.84], Q3: 0.84 [0.76- 0.93], Q4: 0.90 [0.81-1.00], Q5: reference). The same pattern was observed for all four ICE versions. In stratified analyses, similar findings were obtained for White individuals. Among other racial and ethnic groups, estimates were similar but less precise and included the null. Conclusion: Racialized economic segregation was associated with lower CRC screening adherence. Interventions aimed at improving CRC screening uptake in the US should consider targeting structural barriers present in areas that have higher concentrations of low-income minoritized racial and ethnic groups.
Keywords: Colorectal cancer screening, residential segregation