Cancer Screening in Federally Qualified Health Centers by Neighborhood Social Vulnerability: A National Study

Federally Qualified Health Centers (FQHCs) play a critical role in delivering preventive care, including cancer screening, to underserved populations in the United States. Despite widespread adoption of screening, disparities persist, particularly among socioeconomically disadvantaged patients. How neighborhood-level social risk contributes to variation in cancer screening across FQHCs remains unclear.

To examine the association between average patient social risk-measured using patients' ZIP code-level overall and domain-specific Social Vulnerability Index (SVI)-and cancer screening rates across FQHCs.

Retrospective cross-sectional study using 2022 Uniform Data System (UDS) data.

1,312 FQHCs with complete data, serving 29.8 million patients across 50 states and Washington, DC.

FQHC-level social risk was calculated as the patient volume-weighted average SVI score across all patient ZIP codes served by the FQHC. Outcomes were FQHC-level breast, cervical, and colorectal cancer screening rates as defined by 2022 UDS clinical quality measure specifications. Linear regression models adjusted for FQHC characteristics, including patient volume, demographics, chronic condition prevalence, government funding, rurality, and Medicaid expansion status.

Compared with FQHCs serving the least vulnerable communities, those serving the most socially vulnerable neighborhoods had cancer screening rates that were 7.8 percentage points (pp) lower for cervical cancer, 10.9 pp lower for breast cancer, and 15.3 pp lower for colorectal cancer (all p < 0.001). Disparities were largest for colorectal cancer and were most pronounced for the socioeconomic status SVI subdomain. Differences were larger in non-Medicaid expansion states and among larger FQHCs. Findings were consistent across sensitivity analyses.

Substantial disparities in cancer screening persist across FQHCs and are closely linked to the socioeconomic characteristics of the communities they serve. Targeted interventions, sustained funding, and tailored resource allocation for FQHCs serving socially vulnerable populations may help improve screening uptake, reduce preventable disparities, and advance national cancer prevention goals.