Equity Evaluation of an Intervention to Increase Colorectal Cancer Screening at Federally Qualified Health Centers

Racially and ethnically minoritized patients are underscreened for colorectal cancer (CRC), resulting in racial/ethnic disparities. This secondary analysis of a pragmatic patient-randomized clinical trial compared effects of a CRC intervention across race/ethnicity. The multicomponent intervention included a mailed fecal immunochemical test (FIT) for patients in Federally Qualified Health Centers due for screening, plus patient navigation for positive FITs. Among 3,734 patients, 9.7% identified as Hispanic, 29.0% as non-Hispanic Black, and 61.3% as non-Hispanic White, similar across intervention and control arms (P = .73). The adjusted risk difference (RD) for CRC screening uptake between arms was 18.3% (95% CI, 15.6%-20.9%). In stratified analysis, adjusted RDs were 16.7% (95% CI, 7.5%-25.9%) for Hispanic patients, 13.9% (95% CI, 8.6%-19.0%) for non-Hispanic Black patients, and 20.7% (95% CI, 17.2%-24.1%) for non-Hispanic White patients, which did not differ significantly (interaction P = .79). Because the intervention effect did not differ by race/ethnicity, broad implementation among minoritized populations could improve CRC screening disparities.