Social Risks and Nonadherence to Recommended Cancer Screening Among US Adults

Abstract

Importance: Research indicates that social drivers of health are associated with cancer screening adherence, although the exact magnitude of these associations remains unclear.

Objective: To investigate the associations between individual-level social risks and nonadherence to guideline-recommended cancer screenings.

Design, setting, and participants: This cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data from 39 US states and Washington, DC. Analyses for each specific cancer screening subsample were limited to screening-eligible participants according to the latest US Preventive Services Task Force (USPSTF) guidelines. Data were analyzed from February 22 to June 5, 2024.

Exposures: Ten social risk items, including life satisfaction, social and emotional support, social isolation, employment stability, food security (2 questions), housing security, utility security, transportation access, and mental well-being.

Main outcomes and measures: Up-to-date status (adherence) was assessed using USPSTF definitions. Adjusted risk ratios (ARRs) and 95% CIs were estimated using modified Poisson regression with robust variance estimator.

Results: A total of 147 922 individuals, representing a weighted sample of 78 784 149 US adults, were included in the analysis (65.8% women; mean [SD] age, 56.1 [13.3] years). The subsamples included 119 113 individuals eligible for colorectal cancer screening (CRCS), 7398 eligible for lung cancer screening (LCS), 56 585 eligible for cervical cancer screening (CCS), and 54 506 eligible for breast cancer screening (BCS). Findings revealed slight differences in effect size magnitude and in some cases direction; therefore results were stratified by sex, although precision was reduced for LCS. For the social contextual variables, life dissatisfaction was associated with nonadherence for CCS (ARR, 1.08; 95% CI, 1.01-1.16) and BCS (ARR, 1.22; 95% CI, 1.15-1.29). Lack of support was associated with nonadherence in CRCS in men and women and BCS, as was feeling isolated in CRCS in women and BCS. An association with feeling mentally distressed was seen in BCS. Under economic stability, food insecurity was associated with increased risk of nonadherence in CRCS in both men and women, CCS, and BCS; the direction of effect sizes for LCS were the same, but were not statistically significant. Under built environment, transportation insecurity was associated with nonadherence in CRCS in women and BCS, and cost barriers to health care access were associated with increased risk of nonadherence in CRCS for both men and women, LCS in women, and BCS, with the greatest risk and with reduced precision seen in LCS in women (ARR, 1.54; 95% CI, 1.01-2.33).

Conclusions and relevance: In this cross-sectional study of adults eligible for cancer screening, findings revealed notable variations in screening patterns by both screening type and sex. Given that these risks may not always align with patient-centered social needs, further research focusing on specific target populations is essential before effective interventions can be implemented.