Analyzing Factors Influencing Non-Adherence to USPSTF Colorectal Cancer Screening Guidelines Using 2022 BRFSS Data

Authors' Affiliations

Dr. Yan Cao, Center for Nursing Research, College of Nursing, East Tennessee State University, Johnson City, TN Dr. Sheryl Strasser, Department of Health Promotion & Behavior, Georgia State University School of Public Health, Atlanta, USA Dr. Shimin Zheng, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN

Location

D.P. Culp Center Ballroom

Start Date

4-5-2024 9:00 AM

End Date

4-5-2024 11:30 AM

Poster Number

95

Name of Project's Faculty Sponsor

Shimin Zheng

Faculty Sponsor's Department

Biostatistics and Epidemiology

Classification of First Author

Graduate Student-Master’s

Competition Type

Competitive

Type

Poster Presentation

Presentation Category

Health

Abstract or Artist's Statement

Background: Colorectal cancer (CRC) imposes a substantial disease burden with approximately 153,020 new cases and 52,550 deaths reported in 2023 alone. The United States Preventative Services Task Force (USPSTF) advocates for regular screening, recommending fecal occult blood tests or immunochemical tests every three years, sigmoidoscopies every five years, or colonoscopies every ten years. Only 72% of adults were up to date on cancer screening in 2023, with factors such as insurance status and race influencing screening rates. This study aims to conduct a confirmatory analysis using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) with a focus on demographic and health access-related predictors. The objective is to explore real-world associations that contribute to non-compliance with the USPSTF guidelines for CRC screening. Methods: In this study, cross-sectional data from the 2022 Behavioral Risk Factor Surveillance System were utilized, focusing on individuals who responded regarding their adherence to colorectal cancer screening guidelines (n = 93844). Logistic regression analysis was employed to develop a predictive model for non-adherence to these guidelines. The model incorporated factors such as 5-year age groups, health insurance status, gender, race and ethnicity, time elapsed since the last primary care appointment, education level, average monthly alcohol consumption over the past 30 days, and income. Participants with missing data on predictors or screening adherence were excluded from the analysis. Results: Among national participants, 29.2% reported non-compliance with the USPSTF guidelines for CRC screening. The results from the logistic regression model revealed that lacking insurance (OR: 2.65, 95% CI: 2.40 – 2.93), not completing high school (OR: 1.56, 95% CI: 1.42 – 1.72), identifying as non-white or being Hispanic or Latino (OR: 1.14, 95% CI: 1.10 – 1.19), having an income below $35,000 (OR: 1.75, 95% CI: 1.67 – 1.83), and experiencing a longer time since last primary care appointment (5 years since last appointment versus within the last year OR:13.55, 95% CI: 12.24 – 15.01) were significantly and positively associated with non-adherence to screening guidelines. Conversely, being female and average alcohol consumption in the last month had minimal or insignificant impacts on guideline adherence. Conclusion: Our findings underscore the significant impact of health access-related factors, particularly the duration since the last primary care appointment and insurance status, on non-compliance with CRC screening guidelines even when adjusting for common demographic variables. Additionally, socioeconomic status (SES) indicators such as lower education levels and income emerged as notable contributors to non-adherence. These results align with existing research, highlighting the detrimental influence of barriers to health services and lower SES on adherence to screening guidelines. This study lays the groundwork for future longitudinal investigations aimed at exploring CRC guideline adherence within these demographic groups across successive BRFSS cycles.

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Apr 5th, 9:00 AM Apr 5th, 11:30 AM

Analyzing Factors Influencing Non-Adherence to USPSTF Colorectal Cancer Screening Guidelines Using 2022 BRFSS Data

D.P. Culp Center Ballroom

Background: Colorectal cancer (CRC) imposes a substantial disease burden with approximately 153,020 new cases and 52,550 deaths reported in 2023 alone. The United States Preventative Services Task Force (USPSTF) advocates for regular screening, recommending fecal occult blood tests or immunochemical tests every three years, sigmoidoscopies every five years, or colonoscopies every ten years. Only 72% of adults were up to date on cancer screening in 2023, with factors such as insurance status and race influencing screening rates. This study aims to conduct a confirmatory analysis using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) with a focus on demographic and health access-related predictors. The objective is to explore real-world associations that contribute to non-compliance with the USPSTF guidelines for CRC screening. Methods: In this study, cross-sectional data from the 2022 Behavioral Risk Factor Surveillance System were utilized, focusing on individuals who responded regarding their adherence to colorectal cancer screening guidelines (n = 93844). Logistic regression analysis was employed to develop a predictive model for non-adherence to these guidelines. The model incorporated factors such as 5-year age groups, health insurance status, gender, race and ethnicity, time elapsed since the last primary care appointment, education level, average monthly alcohol consumption over the past 30 days, and income. Participants with missing data on predictors or screening adherence were excluded from the analysis. Results: Among national participants, 29.2% reported non-compliance with the USPSTF guidelines for CRC screening. The results from the logistic regression model revealed that lacking insurance (OR: 2.65, 95% CI: 2.40 – 2.93), not completing high school (OR: 1.56, 95% CI: 1.42 – 1.72), identifying as non-white or being Hispanic or Latino (OR: 1.14, 95% CI: 1.10 – 1.19), having an income below $35,000 (OR: 1.75, 95% CI: 1.67 – 1.83), and experiencing a longer time since last primary care appointment (5 years since last appointment versus within the last year OR:13.55, 95% CI: 12.24 – 15.01) were significantly and positively associated with non-adherence to screening guidelines. Conversely, being female and average alcohol consumption in the last month had minimal or insignificant impacts on guideline adherence. Conclusion: Our findings underscore the significant impact of health access-related factors, particularly the duration since the last primary care appointment and insurance status, on non-compliance with CRC screening guidelines even when adjusting for common demographic variables. Additionally, socioeconomic status (SES) indicators such as lower education levels and income emerged as notable contributors to non-adherence. These results align with existing research, highlighting the detrimental influence of barriers to health services and lower SES on adherence to screening guidelines. This study lays the groundwork for future longitudinal investigations aimed at exploring CRC guideline adherence within these demographic groups across successive BRFSS cycles.