C0168 - Decline in Colorectal Cancer Screening Rates in Federally Qualified Health Centers in Los Angeles County From 2019 to 2020

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Yvonne Lei, BA

David Geffen School of Medicine at UCLA
Los Angeles, CA

Yvonne Lei, BA¹, Matthew Y. Zhao, BS¹, Megan R. McLeod, MD, MS¹, Jayraan Badiee, MPH², Artin Galoosian, MD, MA², Folasade P. May, MD, PhD, MPhil³
¹David Geffen School of Medicine at UCLA, Los Angeles, CA; ²University of California, Los Angeles, Los Angeles, CA; ³UCLA, David Geffen School of Medicine, Los Angeles, CA

Introduction: Federally Qualified Health Centers (FQHCs) are funded by the Health Resources and Services Administration (HRSA) to provide primary care services to low-income and underinsured individuals. Los Angeles County (LAC) is a large, diverse county with greater than 10.2 million residents and 8 distinct Service Planning Areas (SPAs) that represent specific geographic regions with variable resources. We aimed to describe colorectal cancer (CRC) screening rates (CRCSR) and the screening rate change (SRCs) in LAC overall and for each SPA between 2019 and 2020 to determine where resources are most needed for CRCSR recovery following the COVID-19 pandemic.

Methods: Our data source was the Uniform Data System (UDS), which includes quality data for the FQHCs funded by HRSA. We determined 2019 and 2020 CRCSR for LAC FQHCs overall and for each FQHC, including average-risk patients age 50-74. We then separated FQHCs into quartiles based on SRC and performed mixed-effects logistic regression to determine FQHC-level characteristics associated with the largest decline in CRCSR from 2019 to 2020 (i.e., predictors of category SRC Q1). Lastly, we determined SRC for each SPA in LAC.

Results: In 2019, there were 58 FQHCs in LAC with 326,473 patients eligible for CRC screening. In 2020, there were 59 FQHCs with 350,405 eligible patients. The median 2020 CRCSR in LAC FQHCs was 37.3%, down from 48.0% in 2019 (2020 median SRC= -9.6%) (Table). In the regression model among all LAC FQHCs, those with higher proportions of patients preferring a non-English language had significantly higher odds of having the largest decline in CRCSR from 2019 to 2020 (SRC Q1) (aOR=3.25, 95% CI=1.22-8.65; data not shown). CRCSR decreased from 2019 to 2020 in all SPAs with SRC ranging from -17.0% (South Bay) to -1.4% (West LA) (Figure).

Discussion: In Los Angeles County FQHCs, CRC screening rates were higher than the national FQHC average in 2019 however declined considerably between 2019 and 2020. The decline in CRC screening rates was highest in FQHCs serving a higher proportion of patients with a preference for a non-English language and varied by county region. Our findings highlight the need for targeted measures, including language-appropriate resources, to improve CRC screening uptake in FQHCs that provide care to some of the most historically marginalized individuals.

Figure: A) Median CRC screening rate among adults age 50 to 74 at FQHCs in Los Angeles County in 2019, by Service Planning Area (SPA). B) Percent change in CRC screening rate (screening rate change, SRC) for adults age 50 to 74 at FQHCs in LA County between 2019 and 2020, by SPA; n=58 FQHCs

Frequency or percent	Overall (n=59)	SRC Q1 (n=15)	SRC Q2+Q3+Q4 (n=44)	p-value
Total patients eligible for CRC screening (age 50-74)	350,405	79,218	271,187	n/a
CRC screening rate in 2019 (median %)	48.0	61.4	44.7	0.0001
CRC screening rate in 2020 (median %)	37.3	37.3	37.3	0.97
Change in CRC Screening Uptake between 2020 and 2019
Median	-9.58	-24.49	-5.52	< 0.0001
Interquartile Range	-15.2, -2.2	-31.4, -17.2	-10.0, -1.3	< 0.0001
Sex Male (median %)	41.5	42.2	41.4	0.83
Race & Ethnicity (median %)
White Non-Hispanic	8.7	6.2	10.2	0.12
Black Non-Hispanic	6.4	4.6	6.7	0.40
Hispanic/Latine	63.5	54.9	63.7	0.94
Other Non-Hispanic	2.6	1.8	2.6	0.16
Preference for non-English Language (median %)	34.1	43.4	33.3	0.01
Urban FQHCs, n (%)	59 (100%)	15 (100%)	44 (100%)	n/a
Experiencing homelessness (median %)	2.3	2.4	2.2	0.57
Income Level >200% FPL (median %)	2.1	1.8	2.2	0.60
Uninsured (median %)	22.6	22.7	22.6	0.72
Medicaid (median %)	41.8	40.0	42.0	0.52
Medicare/Medicaid Dually Eligible (median %)	3.0	2.8	3.0	0.64
Private Ins (median %)	7.1	10.2	6.5	0.19
Agricultural Workers (median %)	0.26	0.30	0.26	0.74

Table: FQHC characteristics (2020 data) and CRC screening rates (2019 and 2020) for HRSA-funded FQHCs in LA County overall and by 2020 CRC screening rate change quartiles.

Disclosures:

Yvonne Lei indicated no relevant financial relationships.

Matthew Zhao indicated no relevant financial relationships.

Megan McLeod indicated no relevant financial relationships.

Jayraan Badiee indicated no relevant financial relationships.

Artin Galoosian indicated no relevant financial relationships.

Folasade May: Exact Sciences – Grant/Research Support. Medtronic – Consultant.

Yvonne Lei, BA¹, Matthew Y. Zhao, BS¹, Megan R. McLeod, MD, MS¹, Jayraan Badiee, MPH², Artin Galoosian, MD, MA², Folasade P. May, MD, PhD, MPhil³. C0168 - Decline in Colorectal Cancer Screening Rates in Federally Qualified Health Centers in Los Angeles County From 2019 to 2020, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.