Racial and ethnic disparities persist in colorectal cancer screening

Foreign-born individuals who recently immigrated to the United States had lower adherence to colorectal cancer screening than foreign-born individuals who have lived in the U.S. longer and those born in the country, data show.

Researchers said the findings highlight the need for culturally and ethnically tailored interventions to improve adherence among people born outside of the U.S.

Eduardo J. Santiago-Rodríguez, MPH, a PhD student at the University of California, San Francisco, and colleagues wrote in the American Journal of Preventive Medicine that longer time lived in the U.S. has been linked to worse health outcomes, particularly for people from racially and ethnically underrepresented groups.

“Preventing [colorectal cancer (CRC)] seems to be at the forefront of the national agenda and discourse of the U.S. government and public health initiatives,” they wrote. “However, true progress against CRC cannot be achieved if healthcare and preventive services are not accessible to all.”

Santiago-Rodríguez and colleagues analyzed data from adults aged 50 to 75 years who participated in the 2010 to 2018 National Health Interview Survey. The researchers divided participants into three categories based on their place of birth and time in the U.S.: U.S.-born people (88% of participants); people born outside of the U.S. who have lived in the country for 15 or more years (12%); and people born outside of the U.S. who have lived there for fewer than 15 years (2%).

Santiago-Rodríguez and colleagues reported that the prevalence of CRC screening adherence — defined according to guidelines from the U.S. Preventive Services Task Force — was 63% overall. The relationship between CRC screening adherence and time in the U.S. differed by race and ethnicity, they wrote.

For the three groups, adherence rates were:

• 64% for people born in the U.S.;
• 55% for people born outside of the U.S. but have lived there for 15 or more years; and
• 35% for people born outside of the U.S. but have lived there for fewer than 15 years.

Broken down by race and ethnicity, the researchers reported that white people had the highest screening adherence rate at 65%, Black people were next at 60%, followed by Asian American or Pacific Islander (AAPI) people at 55% and Latino people at 52%.

Santiago-Rodríguez and colleagues wrote that “it is critical to consider how facilitators of CRC screening might operate differently within racial and ethnic groups.”

“The finding of an inverse association between CRC screening and time in the U.S. is consistent with prior research,” they wrote. “By contrast, differences by race and ethnicity in the sequential analyses have not been previously reported, underscoring the importance of disaggregating (foreign-born) data and adopting a subpopulation focus to better understand health inequalities.”

Additionally, people born in the U.S. had similar rates across racial and ethnic groups, the researchers wrote. For those who have been in the U.S. for at least 15 years, adherence rates were largely similar, ranging from 60% to 64%, except for AAPI people, whose adherence was 52%.

Santiago-Rodríguez and colleagues wrote that, after considering all factors in the study, the role of U.S. citizenship as a facilitator of CRC screening among people born outside of the U.S. “should be emphasized.”

“Culturally and ethnically tailored interventions are needed to improve colorectal cancer screening adherence among foreign-born people, especially among the most recently immigrated individuals,” the researchers wrote.