Racial and Ethnic Disparities in Use of Colorectal Cancer Screening Among Adults With Chronic Medical Conditions: BRFSS 2012-2020

Abstract

Introduction: People with chronic conditions and people with colorectal cancer (CRC) may share common risk factors; thus, CRC screening is important for people with chronic conditions. We examined racial and ethnic differences in the use of CRC screening among people with various numbers of chronic conditions.

Methods: We included data on adult respondents aged 50 to 75 years from the Behavioral Risk Factor Surveillance System in 2012 through 2020. We categorized counts of 9 conditions as 0, 1, 2, 3, and ≥4. We classified self-reported CRC screening status as up to date or not. We used Poisson models to estimate adjusted prevalence ratios (APRs) among the different counts of chronic conditions in 4 racial and ethnic groups: Hispanic adults with limited English proficiency (LEP), Hispanic adults without LEP, non-Hispanic Black adults, and non-Hispanic White adults.

Results: Overall, 66.5% of respondents were up to date with CRC screening. The prevalence of being up to date increased with the number of chronic conditions. We found disparities among racial and ethnic groups. Hispanic respondents with LEP had lower rates than non-Hispanic White adults of being up to date with CRC screening across all counts of chronic conditions (APR for 0 conditions = 0.67; 95% CI, 0.64-0.71; APR for ≥4 conditions = 0.85; 95% CI, 0.79-0.91). Hispanic respondents without LEP with 0, 1, or 2 conditions were less likely than non-Hispanic White respondents to be up to date with CRC screening. We found no significant differences between non-Hispanic Black and non-Hispanic White respondents.

Conclusion: We found disparities among Hispanic BRFSS respondents with LEP, who had lower rates than non-Hispanic White respondents of being up to date with CRC screening, regardless of the number of chronic conditions. Tailored interventions are needed to address these disparities and improve screening rates, particularly among Hispanic people.

Figure 1

Percentage of adults who were not up to date with colorectal cancer screening by race and ethnicity and English-language proficiency, Behavioral Risk Factor Surveillance System, 2012–2020. Hispanic adults who responded to the survey in Spanish were categorized as having limited English proficiency (LEP). Non-Hispanic Black and non-Hispanic White groups were assumed to have English proficiency.

Figure 2

Use of colorectal cancer screening by race, ethnicity, English-language proficiency, and number of chronic conditions, Behavioral Risk Factor Surveillance System (BRFSS), 2012–2020. Adjusted prevalence ratios (APRs) were weighted according to BRFSS methodology. Estimates were obtained from a model that included an interaction term between the number of chronic conditions and race and ethnicity and were adjusted for age, sex, health insurance, and survey year. The reference group for all categories was non-Hispanic White. Hispanic people who responded to the survey in Spanish were categorized as having limited English proficiency (LEP). Error bars indicate 95% CIs.