Residential segregation and colorectal cancer screening in the United States, 2010-2018.

Abstract

Background: Residential segregation limits the access to resources, primarily due to disinvestment. This study evaluated the association between residential segregation and colorectal cancer (CRC) screening in the US, and whether findings differed by race and ethnicity.

Methods: Restricted National Health Interview Survey data (2010-2018) were used to ascertain CRC screening adherence per USPSTF recommendations. Residential segregation was operationalized using the Index of Concentration at the Extremes (ICE), based on income, race, and ethnicity information obtained from the 2014-2018 American Community Survey estimates for counties. Multivariable logistic regression models with robust variance estimators accounting for within-county correlation were used. Analyses were stratified by race and ethnicity, and weighted to represent the US population.

Results: In this cross-sectional study (n=44,690), participants residing in less advantaged counties had lower CRC screening adherence than those residing in the most advantaged counties (Q1 vs Q5, OR [95% CI]: ICE income, 0.77 [0.70-0.86]; ICE race, 0.86 [0.77-0.96]; ICE race+income, 0.75 [0.67-0.84]. In race and ethnicity stratified analyses, we observed that overall findings were mostly driven by White people, and estimates were less precise with no clear gradients among racial and ethnic minoritized groups. Among Black participants, CRC screening did not vary across quintiles of economic segregation.

Conclusions: Residential segregation was associated with CRC screening.

Impact: Interventions aimed at improving CRC screening uptake in the US should address structural barriers present in areas with higher concentrations of low-income minoritized racial and ethnic groups, and how features of residential segregation might diferentially affect racial and ethnic groups.