Colorectal Cancer Screening Disparities Among Race: A Zip Code Level Analysis

Colorectal cancer screening can prevent disease by early identification of precancerous polyps before they progress to cancer. Yet accessibility to CRC screening is still variable among race, geographical location, insurance status, and socioeconomic variables. We include in our analysis publicly available data for zip code-based analysis. We found that the variables that are most related to decreased screening are the social deprivation index and access to health insurance. These data may help implement interventions that target these barriers to promote CRC screenings within disadvantaged communities, which would decrease mortality rates overall. Background: Colorectal cancer (CRC) screening can prevent disease by early identification. Existing disparities in CRC screening have been associated with factors including race, socioeconomic status, insurance, and even geography. Our study takes a deeper look into how social determinants related to zip code tabulation areas affect CRC screenings. Materials and Methods: We conducted a retrospective cross-sectional study of CRC screenings by race at a zip code level, evaluating for impactful social determinant factors such as the social deprivation index (SDI). We used publicly available data from CDC 500 Cities Project (2016-2019), PLACES Project (2020), and the American Community Survey (2019). We conducted multivariate and confirmatory factor analyses among race, income, health insurance, check-up visits, and SDI. Results: Increasing the tertile of SDI was associated with a higher likelihood of being Black or Hispanic, as well as decreased median household income ( P < .01). Lower rates of regular checkup visits were found in the third tertile of SDI ( P < .01). The multivariate analysis showed that being Black, Hispanic, lower income, being uninsured, lack of regular check-ups, and increased SDI were related to decreased CRC screening. In the confirmatory factor analysis, we found that SDI and access to insurance were the variables most related to decreased CRC screening. Conclusion: Our results reveal the top 2 factors that impact a locality's CRC screening rates are the social deprivation index and access to health care. This data may help implement interventions targeting social barriers to further promote CRC screenings within disadvantaged communities and decrease overall mortality via early screening.

Automated summary

Colorectal cancer screening is important for early detection of precancerous polyps, but accessibility to screening varies due to factors such as race, geography, insurance, and socioeconomic status. Data analysis shows that social deprivation and lack of health insurance are the main barriers to CRC screening. Interventions targeting these barriers can help increase screening rates and reduce mortality.