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. 2025 May 4:1-13.
doi: 10.6004/jadpro.2025.16.7.14. Online ahead of print.

Persistent Poverty, Rural Location, and Racial Segregation Are Factors in Colorectal Cancer Screening in Low-Income and Uninsured Populations

Wen Hsin Chen  1 , Rosaleen D Bloom  2 , Arica Brandford  3 , Gang Han  3 , Scott Horel  1 , Marivel Sanchez  1 , Jason Mcknight  4   5 , Jane L Bolin  2
Affiliations

Persistent Poverty, Rural Location, and Racial Segregation Are Factors in Colorectal Cancer Screening in Low-Income and Uninsured Populations

Wen Hsin Chen et al. J Adv Pract Oncol. .

Abstract

Purpose: This study aimed to investigate the correlation between geographical factors, including rurality, persistent poverty counties, racial residential segregation, and adherence to colorectal cancer (CRC) screening among low-income uninsured and underinsured individuals in Texas.

Methods: Utilizing retrospective survey data collected by the A&M Texas Cancer Screening program from 2011 to 2022, linear mixed-effects models were employed. The models examined CRC screening adherence within the recommended time frame as the primary outcome, with geographical county-level characteristics (rurality, racial residential segregation, and persistent poverty) as the main predictors, controlling for other sociodemographic variables.

Findings: The linear mixed-effects analysis revealed that individuals residing in counties characterized by high racial residential segregation (OR = 0.54, 95% CI = 0.36-0.79) or persistent poverty (OR = 0.65, 95% CI = 0.45-0.92) were less likely to self-report having undergone any type of CRC screening within the recommended time frame compared to those in counties with lower racial residential segregation and non-persistent poverty. Conversely, residents of rural counties were more likely to report being up to date with CRC screening compared to their urban counterparts (OR = 1.8, 95% CI = 1.27-2.55).

Conclusions: The findings underscore the need for more targeted CRC screening promotion strategies tailored to low-income, uninsured populations residing in disadvantaged areas such as rural and persistent poverty counties, as well as those characterized by high racial residential segregation.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
County characteristics of C-STEP participants. This identifies the counties within the C-STEP Catchment area that met at least one or a combination of the criteria (persistent poverty, rural, high racial residential segregation).
See this image and copyright information in PMC

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