Nonwhite patients in rural areas ‘even less likely’ to undergo colorectal cancer screening
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CHICAGO — Race, ethnicity and rurality have a significant impact on colorectal cancer screening disparities, highlighting the need for interventions to overcome these barriers, according to data presented at Digestive Disease Week.
“Significant health disparities exist between rural and urban populations,” Gabrielle Waclawik, MD, MPH, chief resident at the University of Wisconsin-Madison School of Medicine and Public Health, told Healio. “These populations are not homogenous, with wide variation existing within and across rural and urban areas.”
Waclawik continued: “In order to reach the National Colorectal Cancer Roundtable goal of 80% screening completion rates in every community, we need a more comprehensive measure of geographic disparities.”
Using electronic health record data from January 2008 to December 2018, Waclawik and colleagues examined the racial/ethnic and geographic variation in CRC screening across primary care clinics in Wisconsin. They identified 462,742 patients (93.7% white) eligible for CRC screening and served by 2,334 providers in 271 clinics across 14 health systems.
Researchers gathered data on CRC screening completion as well as patient, provider, clinic and health system characteristics and calculated average predicted screening rates by race/ethnicity (white/nonwhite) and geolocations (rural advantaged, rural, rural underserved, urban advantages, urban and urban underserved).
Results showed lower CRC screening rates among nonwhite patients compared with white patients (70% vs. 80%) as well as those living in underserved rural (70%) and urban (62%) areas compared with those in urban advantaged (82%), urban (78%), rural (75%) and rural advantaged (73%) areas.
In all three categories of rural communities, nonwhite patients had predicted screening rates of 62% or less, and both white and nonwhite patients in underserved urban areas had predicted screening rates of 65% or less.
“The interaction of race/ethnicity and geolocation showed that nonwhite patients living in a rural area are even less likely to complete CRC screening than their white patient counterparts, as well as compared to nonwhite patients in urban advantaged and urban areas,” Waclawik added. “This represents a significant impact of the intersectionality of race/ethnicity and rurality on CRC screening disparities.
“Interventions, such as the creation or application of specific policies and programs to increase CRC screening in racial/ethnic minorities, should also address barriers specific to the unique needs of their geolocations.”
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Waclawik G, et al. Abstract 408: Impact of race/ethnicity and geolocation on colorectal cancer screening disparities: Double whammy of non-white race and rurality. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago (hybrid).
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