[Differences by sex and determinants in undertaking colorectal cancer screening in Spain (2009-2023)]

This study aimed to examine sex differences and the influence of social determinants of health on the uptake of colorectal screening in Spain from 2009 to 2023.

A cross-sectional analysis was conducted using data from the European Health Interview Survey in Spain (2009, 2014, 2020) and the Spanish Health Survey 2023. The frequency of faecal occult blood test use among individuals aged 50 to 69 was analysed by autonomous community and by variables related to social determinants of health using Chi-square tests. Temporal trends were assessed through joinpoint regression.

Overall, faecal occult blood test uptake increased during the study period, with significant variation across autonomous communities (p<0.005). In 2023, some communities with longer-standing screening programs showed a decline in participation. A joinpoint was identified in 2014, with the annual percentage change decreasing from 33.6% to 10.0% (p<0.005). Higher test utilization was associated with the presence of a screening program, male sex, older age, higher education and income levels, cohabitation, healthy lifestyle behaviours, poorer health status, and urban residence.

The COVID-19 pandemic may have substantially affected screening participation. If the observed annual percentage of change is maintained, participation targets may be reached by the end of this decade. Further analyses incorporating an intersectional gender perspective are essential to understand and address the observed differences in participation between women and men.