E0169 - Colorectal Cancer Screening Rates at Federally Qualified Health Centers in California During the COVID-19 Pandemic: Insights From National Health Resources and Services Administration Data

Award: Presidential Poster Award

Matthew Y. Zhao, BS¹, Yvonne Lei, BA¹, Megan R. McLeod, MD, MS¹, Jayraan Badiee, MPH², Artin Galoosian, MD, MA², Folasade P. May, MD, PhD, MPhil^3
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) provide preventive health services such as colorectal cancer (CRC) screening to low-income and underinsured individuals. California has a racially, ethnically, and socioeconomically diverse population and includes more FQHCs than any other state. Our aim was to assess CRC screening rates and factors impacting the screening rate change (SRC) from 2019 to 2020 at California FQHCs during the COVID-19 pandemic.

Methods: Cross-sectional analyses were performed using the 2019 and 2020 Uniform Data System (UDS) for all FQHCs in California. The UDS provides annual data such as patient demographics and healthcare utilization for all Health Resources and Services Administration-funded health centers. We abstracted CRC screening rates at each FQHC for patients ages 50-74. We then calculated the SRC from 2019 to 2020 for each FQHC, and stratified FQHCs into quartiles by SRC. Wilcoxon rank-sum and chi-square tests were used to assess clinic-level differences between FQHCs in the quartile with the largest decrease in CRC screening rate (SRC Q1) and all other quartiles (SRC Q2-4). Mixed effects logistic regression was used to determine characteristics associated with the largest declines in SRC (being in SRC Q1).

Results: Across all FQHCs in California (n=168), 1,207,401 patients were eligible for CRC screening in 2020. The median CRC screening rate was 36.8% in 2020, down from 44.5% in 2019 (Table). FQHCs with the largest decline in screening (SRC Q1) had a lower percentage of male patients (p=0.010), White (non-Hispanic) patients (p=0.002), and Medicare/Medicaid dually eligible patients (p=0.002). SRC Q1 FQHCs were more likely to have a high percentage of Hispanic/Latinx patients (p=0.002) and patients with a preference for non-English language (p=0.009), and were also more likely to be in an urban setting (p=0.04) (Table). In an adjusted model, serving a higher percentage of Medicare/Medicaid dually eligible patients was associated with lower odds of having the largest SRC decline from 2019 to 2020 (aOR 0.46; 95% CI 0.27-0.81; p=0.007).

Discussion: California FQHCs saw a notable decline in CRC screening rates from 2019 to 2020. Clinic-level factors associated with the greatest declines included the proportion of Medicare/Medicaid dually eligible patients served. This study highlights the need for tailored interventions to address low CRC screening rates in California FQHCs overall, and especially in FQHCs with a high proportion of underinsured individuals.




Disclosures:


Matthew Y. Zhao, BS¹, Yvonne Lei, BA¹, Megan R. McLeod, MD, MS¹, Jayraan Badiee, MPH², Artin Galoosian, MD, MA², Folasade P. May, MD, PhD, MPhil³. E0169 - Colorectal Cancer Screening Rates at Federally Qualified Health Centers in California During the COVID-19 Pandemic: Insights From National Health Resources and Services Administration Data, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.