Assessment of Colorectal Cancer Screening Disparities in U.S. Men and Women Using a Demographically Representative Sample

Timely receipt of colorectal cancer screening can reduce morbidity and mortality. This is the first known study to adopt Andersen's model of health services use to identify factors associated with colorectal cancer screening among U.S. adults. The data from National Health Interview Survey from 2019 was utilized to conduct the analyses. Multivariable logistic regression was used to separately analyze data from 7,503 age-eligible women and 6,486 age-eligible men. We found similar colorectal cancer screening levels among men (57.7%) and women (57.6%). Factors associated with higher screening odds in women were older age, married/cohabitating with a partner, Black race, >bachelor's degree, having a usual source of care, and personal cancer history. Factors associated with lower odds for women were American Indian/Alaska Native race, living in the United States for ≤10 years, ≤138% federal poverty level (FPL), uninsured or having Medicare, and in fair/poor health. For men, factors associated with higher screening odds were older age, homosexuality, married/cohabitating with a partner, Black race, >high school/general educational development education, having military insurance, having a usual source of care, and personal cancer history. Factors associated with lower odds for men were being a foreign-born U.S. resident, living in the South or Midwest, ≤138% FPL, and being uninsured or having other insurance. Despite lower screening rates in the past, Black adults show a significantly higher likelihood of colorectal cancer screening than White adults; yet, screening disparities remain in certain other groups. Colorectal cancer screening efforts should continue to target groups with lower screening rates to eliminate screening disparities. SIGNIFICANCE: Timely receipt of colorectal cancer screening can reduce morbidity and mortality. Identification of populations and domains of factors associated with colorectal cancer screening receipt among men and women can help future interventions to alleviate impeding factors and target screening promotion efforts in populations not adherent with screening guidelines.