Disparities In Uptake of the 2021 United States Preventive Services Task Force Colorectal Cancer Screening Recommendations Among Adults Aged 45-49.

Abstract

Background: Colorectal cancer screening lowers mortality, and in 2021, the United States Preventive Services Task Force lowered the recommended age to start colorectal cancer screening for average-risk adults from 50 to 45. However, social and structural factors impact access to screening, and sociodemographic disparities in uptake of the recommendation to begin colorectal cancer screening at age 45 has not been studied among the general population.

Objective: Examine disparities in uptake of the 2021 United States Preventive Services Task Force recommendation to start colorectal cancer screening at age 45.

Design: Utilizing 2022 and 2023 Behavioral Risk Factor Surveillance System data, we examined factors associated with colorectal cancer screening using multivariable logistic regression models.

Setting: Data from the Behavioral Risk Factor Surveillance System national phone survey.

Patients: Adults aged 45-49.

Main outcome measure: Colorectal cancer screening.

Results: Higher proportions of people with low-income, limited education, no health insurance, and rural residence were unscreened. Uninsured individuals had the lowest odds of undergoing screening (OR = 0.48, 95% CI= 0.37-0.63). Among insured people, low-income (OR = 0.83, 95% CI = 0.73-0.93) and low-education (OR = 0.69, 95% CI = 0.51-0.94) individuals had lower odds of screening; rural uninsured individuals had lower odds of screening than their urban uninsured counterparts (OR = 0.57, 95% CI = 0.37-0.89).

Limitations: We could not identify individuals with polyps or family histories of hereditary cancer syndromes who would be recommended for early screening regardless of the 2021 guidelines.

Conclusions: Sociodemographic disparities exist in uptake of the 2021 United States Preventive Services Task Force recommendation to start colorectal cancer screening at age 45. Uninsured people had the lowest odds of screening, and uninsured rural individuals had lower odds of screening than their uninsured urban counterparts. Insured low-income and low-education individuals had lower odds of accessing colorectal cancer screening than their higher-income and higher-educated counterparts. Expanding insurance coverage among adults aged 45-49 may increase access to colorectal cancer screening. See Video Abstract.