Likelihood of colorectal cancer screening by poor health status: A cross-sectional analysis of the Behavioral Risk Factor Surveillance System 2022.

Abstract

e15677 Background: Professional societies recommend against colorectal cancer (CRC) screening for adults over the age of 75, particularly those with a life expectancy of less than 10 years due to a higher risk of complications from procedures and overdiagnosis. However, limited data exist for CRC screening practices in frail adults aged 45–75 with poor health. We aimed to explore the relationship between self-reported health and CRC screening in this population to understand the role of screening in their care and optimize its benefits. Methods: We conducted a cross-sectional analysis of adults aged 45–75 who responded to the 2022 Behavioral Risk Factor Surveillance System, a telephone survey administered by the Centers for Disease Control and Prevention. Our primary exposure was self-reported general health as excellent, very good, good, fair, or poor. Our outcome was being up-to-date with CRC screening recommendations, according to US Preventive Services Task Force 2021 guidelines. Multivariable logistic regression analyses estimated associations between health status and CRC screening, adjusting for sociodemographic factors and comorbidities. Results: Among 207,565 eligible respondents representing ~103 million individuals, 66.3% were up-to-date with CRC screening. Adults with ‘fair’ or ‘poor’ health were more frequently older, female, racially Black, ethnically Hispanic, uninsured, with lower education, lower salaries, and more comorbidities. After adjustment, adults reporting worse health were more likely to be up-to-date with CRC screening: fair vs. excellent (adjusted OR 1.23, 95% CI 1.11–1.37) and poor vs. excellent (adjusted OR 1.33, 95% CI 1.14–1.53). Conclusions: Adults aged 45–75 with worse self-reported health were more likely to undergo CRC screening. Further research is needed to evaluate the role of screening in this population in order to screen adults most likely to benefit and avoid screening those less likely to benefit. Association between health status and colorectal cancer screening (N=207,565). Self-reported Health Excellent Very Good Good Fair Poor Total Eligible adults Unweighted, n 30,858 70,430 66,348 29,425 10,504 Total Eligible adults Weighted, n 14,819,665 32,347,717 33,012,227 15,588,416 5,613,383 Up to date with screening 63.6% 68.2% 65.8% 64.2% 64.5% Unadjusted OR (95% CI) Reference 1.23 (1.15–1.31) 1.10 (1.03–1.18) 1.03 (0.96–1.11) 1.04 (0.94–1.15) Adjusted OR (95% CI) a Reference 1.13 (1.04–1.23) 1.16 (1.07–1.27) 1.23 (1.11–1.37) 1.33 (1.14–1.53) OR: odds ratio; CI: confidence interval. a Multivariable logistic regression analyses adjusted for age, sex, race and ethnicity, income, education, health insurance status, and comorbidities: heart attack/heart disease, stroke, COPD, depression, diabetes, heavy alcohol use (men: 14+ drinks/week, women: 7+ drinks/week), BMI >25, and tobacco use.