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Colorectal Cancer Screening and Social Needs.

Isabelle R Franklin1, Rebecca Gambatese2, Mark C Duggan2

  • 1From the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (IRF, EEH, CAS); Kaiser Permanente Bernard J. Tyson School of Medicine, Office of Research and Scholarship, Pasadena, CA (RG, MCD); Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA (BBG, RSN, QNM); Kaiser Permanente Washington Health Research Institute, Seattle, WA (BBN); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (GDC); Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA (EEH); Hawaii Permanente Medical Group, Honolulu, HI (SAH); The Southeast Permanente Medical Group, Atlanta, GA (KK); Kaiser Permanente Division of Research, Oakland, CA (TRL); Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO (CAS). isabelle.r.franklin@kp.org).

Journal of the American Board of Family Medicine : JABFM
|January 2, 2025
PubMed
Summary

Social needs like financial strain, social isolation, and food insecurity significantly impact colorectal cancer (CRC) screening rates, even in insured populations. Addressing these social determinants of health is crucial for improving CRC screening. Keywords: colorectal cancer screening, social needs, financial strain, social isolation, food insecurity.

Keywords:
Cancer ScreeningColorectal CancerCross-Sectional StudiesSocial Determinants of HealthSocial Factors

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Area of Science:

  • Public Health
  • Preventive Medicine
  • Health Disparities

Background:

  • Colorectal cancer (CRC) is a leading cause of cancer death in the U.S.
  • Patient-reported barriers to CRC screening are known, but the impact of social needs is less understood.
  • Few studies have analyzed how social needs influence CRC screening rates.

Purpose of the Study:

  • To investigate the association between patients' social needs and their adherence to colorectal cancer (CRC) screening guidelines.
  • To identify specific social needs that act as barriers to CRC screening completion.
  • To inform strategies for improving CRC screening rates by addressing social determinants of health.

Main Methods:

  • Cross-sectional study of 3,443 Kaiser Permanente patients aged 50-75 years.
  • Assessed five social needs categories: financial strain, housing instability, transportation issues, social isolation, and food insecurity.
  • Determined CRC screening status using electronic health records based on Health care Effectiveness Data and Information (HEDIS) criteria; analyzed associations using multivariable analyses.

Main Results:

  • 81.5% of patients were up to date on CRC screening.
  • Severe financial strain (OR 2.1), social isolation (OR 1.9), and food insecurity (OR 2.5) were significantly associated with lower odds of being up to date on screening.
  • Severe transportation issues and housing instability showed non-significant trends towards lower screening rates.

Conclusions:

  • Social needs, including financial strain, social isolation, and food insecurity, are linked to lower CRC screening rates, even in fully insured individuals.
  • Addressing social determinants of health is essential for enhancing CRC screening adherence.
  • Future research should explore interventions targeting social needs to improve CRC screening.