P0279 - Colorectal Cancer Screening Rates at HRSA-funded Health Centers in the United States Lag Behind the National Rate

Award: Outstanding Research Award in the Colorectal Cancer Prevention Category (Trainee)
Award: Presidential Poster Award

Award: Outstanding Research Award in the Colorectal Cancer Prevention Category (Trainee)

Award: Presidential Poster Award

Megan R. McLeod, MD, MS¹, Matthew Y. Zhao, BS¹, Liu Yang, MD, MPH², Folasade May, MD, PhD^3
1David Geffen School of Medicine, UCLA, Los Angeles, CA; ²David Geffen School of Medicine at UCLA, Los Angeles, CA; ³University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA

Introduction: Screening for colorectal cancer (CRC) significantly reduces incidence and mortality. Screening is typically initiated by primary care providers, and the Health Resources and Services Administration (HRSA) provides primary care services to 30 million Americans. Given known disparities in CRC screening and new United States Preventive Services Task Force (USPSTF) screening guidelines, we aimed to assess screening rate gaps among vulnerable populations that receive care at HRSA-funded organizations. We also estimated the population newly eligible for screening in this setting, and identified sociodemographic factors associated with higher screening rates.

Methods: Our cross-sectional analysis used data from the 2019 Uniform Data System (UDS), which includes patient and quality data for the entire HRSA-funded population. We determined the population eligible for screening (2019 and 2021) and the mean percentage of eligible patients screened. We used linear regression to determine patient composition characteristics associated with the percentage screened in HRSA organizations.

Results: Among 1342 HRSA organizations across 50 states, there were 7,122,860 patients eligible for CRC screening in 2019 (age 50-74). An additional 1,746,870 patients age 45-49 represent the cohort newly eligible for screening in 2021 (Table 1). The overall average screening rate was 42.6% (versus 68.8% BRFSS national rate for 2018). Screening rates were significantly negatively associated with percent male patients (-31.9, 95%CI=-46, -17), percent non-Hispanic Black patients (-8.0, 95%CI=-12, -4), percent non-Hispanic American Indian/Alaskan Native patients (-11.6, 95%CI=-21, -1.9), percent uninsured patients (-18.1, 95%CI=-23.1, -13.0) percent of patients living in poverty (-6.3, 95%CI=-10.2, -2.3) and percent homeless patients (-15.3, 95%CI=-21, -10.2). Screening rates were significantly positively associated with percent non-Hispanic White patients (4.0, 95%CI=1.1, 7.1) and percent of patients best served in a language other than English (9.3, 95%CI=4.8, 14).

Discussion: The average CRC screening rate among the 1342 U.S HRSA-funded organizations was far below the national average. Our findings highlight the need for ongoing measures to improve CRC screening uptake at HRSA-funded health centers that serve medically underserved populations, including millions newly eligible for screening under the new USPSTF colorectal cancer screening guidelines.


Figure: Figure 1. Colorectal cancer (CRC) screening rates (mean %) among eligible adults (age 50-75) at Health Resources and Services Administration-funded organizations in 2019.

Frequency or Percent	USA	California	Alaska	Texas	New York	Michigan
Number of Organizations	1342	179	17	72	62	39
Total patients	29,105,657	5,334,211	115,116	1,603,876	2,253,908	705,873
Total patients age 50-74	7,122,860	1,253,752	33,435	353,228	520,500	181,181
Total patients age 45-49	1,746,870	321,980	6,090	95,110	129,064	42,136
Sex (mean %)
Male	43.6	44.1	50.3	40.6	45.1	43.7
Female	56.4	55.9	49.7	59.4	54.9	56.3
Race/Ethnicity (mean%)
Non-Hispanic
White	42.1	23.7	43.1	25.8	27.9	51.0
Black	18.5	7.1	1.6	14.0	24.4	25.8
Asian	3.3	8.8	3.6	1.6	4.7	1.4
American Indian or Alaskan Native	2.1	0.9	33.1	0.2	0.3	1.8
Hawaii Native or Pacific Islander	0.6	0.5	0.9	0.1	0.3	0.1
More than one race	1.4	1.1	3.1	0.6	1.6	1.5
Hispanic/Latino	26.5	51.3	5.0	53.8	29.7	10.9
Unknown	5.6	6.5	9.5	4.0	11.2	7.5
Preference for non-English Language (mean%)	18.2	33.1	3.2	25.4	21.8	9.6
Seasonal or Migrant Farm Workers (mean%)	2.5	5.0	0.2	1.3	1.0	1.4
Homeless (mean%)	7.1	9.0	2.2	7.8	11.3	5.7
Income Level (mean%)
< 100% Federal Poverty Level (FPL)	45.7	57.6	19.1	45.6	43.4	42.2
101-150% FPL	11.1	12.9	8.4	12.0	8.2	10.1
151-200% FPL	5.9	5.3	7.0	5.8	5.0	6.1
>200% FPL	7.2	5.5	10.3	5.9	7.4	7.2
Unknown	30.2	18.9	55.2	30.7	36.1	34.3
Insurance Type (mean%)
Uninsured	24.9	20.9	21.7	45.3	13.1	14.1
Medicaid	42.4	60.9	30.8	23.2	55.4	50.4
Medicare	11.2	8.4	11.1	8.1	9.9	13.6
Other Public Insurance	0.6	0.5	0.1	3.1	2.2	0.0
Private	20.9	9.4	36.4	20.3	19.5	21.6
Urban Organizations (mean%)	58.0	78.8	7.6	57.0	80.7	66.7
CRC Screening Uptake
Percent Screened (mean)	42.6	43.2	35.6	35.9	42.6	44.4
Percent Screened (median)	42.7	44.2	33.5	33.1	46.0	44.3
Range of CRC screening (raw percentage)	0.29-94.3	5.1-92.9	2.3-93.8	3.3-87.1	8.2-72.7	2.9-78.3

Table: Table 1. Sociodemographic profiles and CRC screening rates for FQHCs in selected States, 2019


Disclosures:
Megan McLeod indicated no relevant financial relationships.
Matthew Zhao indicated no relevant financial relationships.
Liu Yang indicated no relevant financial relationships.
Folasade May indicated no relevant financial relationships.


Megan R. McLeod, MD, MS¹, Matthew Y. Zhao, BS¹, Liu Yang, MD, MPH², Folasade May, MD, PhD³. P0279 - Colorectal Cancer Screening Rates at HRSA-funded Health Centers in the United States Lag Behind the National Rate, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.