C0184 - Colorectal Cancer Screening Rates at Federally Qualified Health Centers in 2019 and 2020 Varied Based on Urban-Rural Status and Predominant Racial/Ethnic Group

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Megan R. McLeod, MD, MS

David Geffen School of Medicine at UCLA
Los Angeles, CA

Award: Presidential Poster Award

Megan R. McLeod, MD, MS¹, Matthew Y. Zhao, BS¹, Yvonne Lei, BA¹, Artin Galoosian, MD, MA², Jayraan Badiee, MPH², 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: Over 30 million low-income and underinsured individuals in the U.S. receive primary care services, including colorectal cancer (CRC) screening, at Federally Qualified Health Centers (FQHCs). Given known differences in healthcare access in rural settings, we aimed to quantify CRC screening rates and factors associated with a decline in screening between 2019 and 2020 at FQHCs based on urban-rural status.

Methods: We abstracted data from the Uniform Data System (UDS)—which compiles preventive health utilization data, including CRC screening rates among patients ages 50-74—for each FQHC. Our primary outcome was screening rate change (SRC), calculated as 2020 CRC screening rate minus 2019 CRC screening rate. We separated FQHCs based on urban-rural status and then created quartiles based on SRC. We used Wilcoxon Rank-Sum and x² testing to compare rural and urban FQHCs and performed backward stepwise multivariable logistic regression to determine FQHC-level characteristics (2020 data) associated the largest decline in screening participation between 2019 and 2020 (SRC Q1 status).

Results: In 2020, 734 urban and 527 rural FQHCs served 6,438,433 patients who were age-eligible for CRC screening. FQHC characteristics were significantly different between urban and rural FQHCs (Table). CRC screening rates were lower in rural FQHCs than urban FQHCs in 2019 (p=0.04) and 2020 (p< 0.0001), and SRC was lower in urban (-3.6%) than rural (-1.2%) FQHCs (p< 0.0001) (Table). Urban FQHCs were more likely to see a decline in CRC screening in 2020 if they served a majority non-Hispanic Black patients (aOR 2.05, 95%CI=1.19-3.52) or if they served a high proportion of uninsured patients (data not shown). Rural FQHCs were more likely to see a decline in CRC screening in 2020 if they served a majority Hispanic/Latinx patients (aOR 2.78, 95% CI=1.50-5.15) or if they were in a non-Medicaid expansion state (aOR 1.81, 95% CI 1.09-2.99) (data not shown). SRC was calculated by state for rural FQHCs and mapped in the Figure.

Discussion:

Urban FQHCs had a greater decline in CRC screening rates from 2019 to 2020 than rural FQHCs and experienced larger declines if the patient population was predominantly Black or uninsured. Rural FQHCs saw a steep decline if they served a majority Hispanic/Latinx population or were in a non-Medicaid expansion state. These findings suggest that efforts to increase CRC screening at US FQHCs may need to be tailored to their location, demographics, and insurance and Medicaid eligibility status.

Figure: Figure. Map of screening rate change (2020 CRC screening rate – 2019 CRC screening rate) by state for rural FQHCs and indication of Medicaid expansion status as of 2020.

	All FQHCs (n=1261)	Urban FQHCs (n=734)			Rural FQHCs (n=527)			p-value*
Frequency or percent	All FQHCs (n=1261)	SRC Q1 (n=218)	SRC Q2+Q3+Q4 (n=516)	Total (n=734)	SRC Q1 (n=98)	SRC Q2+Q3+Q4 (n=429)	Total (n=527)
Total patients eligible for CRC screening (age 50-74)	6,438,433	1,328,330	2,811,734	4,140,064	483,110	1,815,259	2,298,369	n/a
CRC screening rate in 2019 (median %)	42.9	48.0	38.3	41.6	48.5	43.7	44.7	0.04
CRC screening rate in 2020 (median %)	38.8	32.4	38.8	36.9	32.7	43.9	42.4	< 0.0001
Median 2019-2020 SRC	-2.7	-13.7	-1.2	-3.6	-12.6	0.1	-1.2	< 0.0001
Male patients (median %)	42.9	42.1	42.3	42.2	43.4	43.9	43.8	< 0.0001
Majority Race/Ethnicity served at FQHC (median %)
Non-Hispanic White	36.4	16.0	25.2	21.7	66.9	70.4	70.1	< 0.0001
Non-Hispanic Black	8.2	12.7	19.1	17.3	2.6	1.6	1.6	< 0.0001
Hispanic/Latinx	15.8	33.4	24.7	26.8	7.7	5.5	6.1	< 0.0001
Other Non-Hispanic	4.6	5.2	5.9	5.7	2.5	3.4	3.3	< 0.0001
Patients with a preference for non-English Language (median %)	11.7	27.1	17.9	19.2	6.7	3.5	3.8	< 0.0001
Patients experiencing homelessness (median %)	1.8	3.2	2.6	2.7	1.1	1.0	1.0	< 0.0001
Patients with income Level >200% FPL (median %)	4.6	2.9	3.8	3.5	6.5	8.1	7.8	< 0.0001
Uninsured patients (median %)	19.6	23.9	21.5	22.3	19.7	16.2	16.7	< 0.0001
Medicaid Expansion (%)	71.6	76.6	73.6	74.5	59.2	69.5	67.6	0.007

Table: Table. FQHC characteristics (2020 data), colorectal cancer (CRC) screening rates (2019 and 2020), and screening rate changes (SRC) for urban and rural FQHCs in the US overall and by SRC comparison groups. *p-values represent Wilcoxon rank-sum or chisq tests comparing overall characteristics between urban and rural FQHCs.

Disclosures:

Megan McLeod indicated no relevant financial relationships.

Matthew Zhao indicated no relevant financial relationships.

Yvonne Lei indicated no relevant financial relationships.

Artin Galoosian indicated no relevant financial relationships.

Jayraan Badiee indicated no relevant financial relationships.

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

Megan R. McLeod, MD, MS¹, Matthew Y. Zhao, BS¹, Yvonne Lei, BA¹, Artin Galoosian, MD, MA², Jayraan Badiee, MPH², Folasade P. May, MD, PhD, MPhil³. C0184 - Colorectal Cancer Screening Rates at Federally Qualified Health Centers in 2019 and 2020 Varied Based on Urban-Rural Status and Predominant Racial/Ethnic Group, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.