Low Colorectal Cancer Screening Uptake and Persistent Disparities in an Underserved Urban Population

Area of Science:

• Public Health
• Gastroenterology
• Health Services Research

Background:

• Colorectal cancer screening rates have risen, but telephone surveys may underestimate uptake in underserved groups.
• Safety-net hospitals serve vulnerable populations where screening disparities may persist.
• Primary care providers (PCPs) are key facilitators of colorectal cancer screening.

Purpose of the Study:

• To measure colorectal cancer screening completion within one year of a primary care visit.
• To identify sociodemographic and health-related predictors of screening completion among previously unscreened patients.
• To assess overall screening uptake in an underserved urban population.

Main Methods:

• Retrospective cohort study of 21,256 patients aged 50-75 at a safety-net hospital in 2014.
• Compared screening completion within 1 year of an initial PCP visit versus remaining unscreened.
• Multivariable logistic regression analysis to identify predictors of screening.

Main Results:

• 11.5% of eligible patients completed screening within one year of a PCP visit.
• Asian race, more PCP visits, and higher area-level income predicted higher screening completion.
• Morbid obesity, smoking history, low comorbidity index, and Medicaid/Medicare insurance were associated with remaining unscreened.

Conclusions:

• Colorectal cancer screening disparities persist in underserved urban settings, with overall low uptake.
• Increased PCP visits correlated with slightly higher screening completion, suggesting potential for intervention.
• Community-level education and outreach are essential to improve colorectal cancer screening in vulnerable populations.