Neighborhood Factors Related to Cancer Screening in Texas: A Spatioecological Study

The purpose of this study is to examine the associations of neighborhood socioeconomic status, ethnic enclaves, and residential Black segregation with screening for breast, cervical, and colorectal cancers across the state of Texas.

Using an ecologic study design, spatial clustering of low breast, cervical and colorectal cancer screening rates were identified across Texas census tracts using local Moran's I statistics. Binomial spatial probit regression was used to estimate the associations between nSES, Hispanic/Latino and Asian American ethnic enclave neighborhoods and residential Black segregation with geospatial clusters of low screening, adjusting for behavioral characteristics. Analysis was conducted in 2024.

Of 5,186 tracts, 5.4%, 4.6%, and 8.7% tracts were in low screening clusters for colorectal, cervical, and breast cancer, respectively. Medium and high neighborhood socioeconomic status tracts had reduced odds of being part of low cervical cancer screening clusters. Medium neighborhood socioeconomic status tracts and Hispanic enclave tracts had increased odds of being within a low breast cancer screening cluster. Asian American enclave tracts displayed an increased odds of being in low colorectal cancer and low cervical cancer screening clusters. Tracts with high residential Black segregation demonstrated reduced odds of being in low colorectal cancer and low breast cancer screening clusters.

Geospatial clusters of screening uptake are associated with neighborhood socioeconomic status and racial and ethnic neighborhood characteristics. This indicates a need for place-based culturally sensitive interventions to address the specific assets and needs of communities with low screening uptake.