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Persistent Poverty, Rural Location, and Racial Segregation Are Factors in Colorectal Cancer Screening in Low-Income
Wen Hsin Chen1, Rosaleen D Bloom2, Arica Brandford3
1From Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas.
Journal of the Advanced Practitioner in Oncology
|July 2, 2025
Summary
Geographical factors like poverty and segregation reduce colorectal cancer (CRC) screening adherence in Texas. Rural residents, however, show higher CRC screening rates, indicating a need for targeted interventions.
Area of Science:
- Public Health
- Health Disparities
- Cancer Screening
Background:
- Colorectal cancer (CRC) screening is crucial for early detection and improved outcomes.
- Disparities in screening exist among low-income, uninsured, and underinsured populations.
- Geographical factors may influence access to and adherence to cancer screening services.
Purpose of the Study:
- To investigate the correlation between geographical factors (rurality, persistent poverty, racial residential segregation) and CRC screening adherence.
- To analyze these correlations among low-income, uninsured, and underinsured individuals in Texas.
Main Methods:
- Retrospective survey data from the A&M Texas Cancer Screening program (2011-2022) were analyzed.
- Linear mixed-effects models were used to assess CRC screening adherence as the primary outcome.
- County-level geographical characteristics were the main predictors, controlling for sociodemographic variables.
Main Results:
- High racial residential segregation and persistent poverty were associated with lower likelihood of CRC screening adherence (OR=0.54, OR=0.65 respectively).
- Residents of rural counties were more likely to be up-to-date with CRC screening compared to urban residents (OR=1.8).
Conclusions:
- Findings highlight the impact of socioeconomic and racial factors on CRC screening adherence.
- Targeted screening promotion strategies are needed for disadvantaged populations in rural, high-poverty, and high-segregation areas.
- Addressing geographical disparities is essential for improving CRC screening rates.
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