Trends and Factors Associated with Fecal Occult Blood Test Utilization among Hispanic Adults in Puerto Rico and the United States: BRFSS 2012-2020

Abstract

Identifying factors associated with colorectal cancer screening utilization is important to guide colorectal cancer prevention and control programs. We evaluated trends and factors associated with previous-year fecal occult blood test (FOBT) use among Hispanic adults living in Puerto Rico and the U.S. mainland. Using data from the Behavioral Risk Factor Surveillance System (2012-2020), trends in FOBT use were analyzed using joinpoint regression to estimate annual percentage change (APC). Logistic regression stratified by location identified factors associated with FOBT use. FOBT was more common among Hispanic adults ages 50 to 75 years living in Puerto Rico than in the U.S. mainland [Puerto Rico: 20.5%[2012] to 45.6%[2020], APC = 11.4%; U.S. mainland: 9.9%[2012] to 16.7%[2020], APC = 5.9%]. Factors inversely associated with FOBT use were similar in Puerto Rico and the U.S. mainland, including lack of health insurance, not having a personal doctor, having a checkup >12 months ago, and not being able to see a doctor due to cost, as were factors associated with higher FOBT use, including older age, retirement, or having two or more chronic diseases. Among Hispanics living in the U.S. mainland, lack of exercise and less education were inversely associated with FOBT. Factors related to poor access to healthcare were associated with lower use of FOBT among Hispanics. Efforts to improve colorectal cancer screening in Hispanics are necessary to address health disparities across the colorectal cancer care continuum.

Prevention relevance: Colorectal cancer screening reduces cancer incidence and mortality. All screening modalities, including less invasive FOBT tests, are underutilized, especially in non-White and low-income populations. Evaluation of trends and factors associated with the increase in the use of colorectal cancer screening can inform programs to address the lack of screening among racial minorities.

Figure 1.. Trends of colorectal cancer screening used last year of the interview among Hispanics living in Puerto Rico and Hispanics living in the mainland US.

Joinpoint regression was used to evaluate the change in the trend of FOBT use over the study period. FOBT= Fecal occult blood test, AAPC = Average Annual Percent change. Numbers are not mutually exclusive, participants can have more than one of the colorectal screening tests

Figure 2.. Monthly trends of colorectal cancer screening use last year of the interview among Hispanics living in Puerto Rico and the mainland US of the interview.

Joinpoint regression was used to evaluate the change in the trend of FOBT use over the study period. FOBT= Fecal occult blood test, MPC = Monthly Percent change. Numbers are not mutually exclusive, participants can have more than one of the colorectal screening tests