Socioeconomic status, rurality may represent ‘unique barriers’ to CRC screening uptake
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Key takeaways:
- CRC screening significantly increased after the 2021 USPSTF recommendation to screen average-risk individuals aged 45 to 49 years.
- Increases were higher in high socioeconomic status and metropolitan areas.
Despite a twofold increase in colorectal cancer screening among average-risk individuals aged 45 to 49 years after the 2021 recommendation, disparities in socioeconomic status and locality underscore the need for targeted interventions.
“Although insurance is a key factor influencing an individual’s ability to access CRC screening, little is known about the uptake of this service among insured individuals in light of the recent policy recommendation by the USPSTF encouraging average-risk individuals to start receiving screening at the age of 45,” Sunny Siddique, MPH, a researcher in the department of chronic disease epidemiology at Yale School of Public Health, told Healio. “Therefore, we wanted to understand the patterns of screening uptake and possible disparities based on individual and area-level factors among insured individuals.”
In a retrospective cohort study published in JAMA Network Open, Siddique and colleagues used deidentified commercial claims data from Blue Cross Blue Shield Axis to investigate the link between the May 2021 U.S. Preventive Services Task Force recommendation and changes in screening among insured, average-risk individuals aged 45 to 49 years. They included 10,221,114 beneficiaries (mean age, 47.04 years; 51.04% women) and compared uptake 20 months before (May 2018-December 2019; n = 3,213,935) and after (May 2021-December 2022; n = 2,923,327) the USPSTF recommendation.
According to results, uptake increased from 0.5% before the recommendation to 1.51% after the recommendation — “a twofold increase in CRC screening,” Siddique said.
Although these individuals had a higher absolute change in screening of 1.01 percentage points (95% CI, 0.62-1.4), the relative change was not significant (202.51%; 95% CI, –30.59 to 436.87).
Siddique also noted that those living in “the top 20% of socioeconomic status” had a 67% higher increase vs. those living in the “bottom 20%,” with an absolute change in screening of 1.25 percentage points (95% CI, 0.77-1.74) vs. 0.75 percentage points (95% CI, 0.47-1.02). Similar to overall findings, the relative change was not significant (214.01%; 95% CI, –30.91 to 461.15 vs. 167.73%; 95% CI, –16.3 to 352.63).
“Additionally, metropolitan area residents had a 45% higher increase in screening compared with nonmetropolitan area residents,” Siddique said.
Screening uptake increased the fastest after the recommendation among those living in areas with the highest socioeconomic status (0.24 percentage points every 2 months; 95% CI, 0.23-0.25), as well as among those in metropolitan areas (0.2 percentage points every 2 months; 95% CI, 0.19-0.21).
Overall, 11.5% of average-risk beneficiaries aged 45 to 49 years underwent screening after the recommendation.
“These results show that there may be unique barriers experienced by individuals residing areas with low socioeconomic status and rural areas to receive CRC screening, despite having access to insurance,” Siddique told Healio. “Introducing interventions to increase screening, such as patient navigation, active distribution of fecal blood tests, as well as strategic presentation of screening tests and automated referrals to colonoscopy, may help increase screening for all.”
He continued: “Future research identifying the unique barriers faced by population subgroups, looking at the uptake of alternative screening modalities and identifying ways to increase the receipt of colonoscopies following an abnormal test result from these alternative modalities is needed.”
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