Relationship between access to shelter arrangement and adherence to breast, cervical, and colorectal cancer screening in the Providence's unhoused population.

Abstract

e13771 Background: Unhoused individuals have higher cancer death rates and reduced cancer screening. In Rhode Island, the number of unhoused individuals increased 35% in 2024, with a significant rise in the number of unsheltered individuals. We sought to determine if there was a difference in cancer screening amongst individuals sleeping in a shelter as compared to those sleeping outside (unsheltered). Methods: We conducted semi-structured interviews with unhoused adult individuals in Providence, Rhode Island from Sept 2023 to April 2024. Demographics, shelter arrangements, and barriers to cancer screening were collected. Having up to date breast, cervical, and colorectal cancer screening were defined as per the USPSTF recommendations for the general population. This study was approved by the Brown University Health Institutional Review Board. Results: Of the 502 study participants, 359 had stable shelter arrangements and 143 were unsheltered at the time of the interview. Compared to those with shelter arrangements, unsheltered participants were younger [mean age 49.7 vs. 54.0 (95% CI -6.2 – -2.3)], had higher rates of cigarette smoking [87.4% vs. 64.1% (95% CI 15.9 – 30.1)] and alcohol use [55.2% vs. 40.9% (95% CI 4.7 – 23.9)], and less likely to have a primary care provider [55.2% vs. 71% (95% CI -25.2 – -6.4)]. There were no statistically significant differences regarding gender, educational level, and active health insurance among the two groups. In univariate regression models, unsheltered participants were less likely to be up-to-date with breast [15.6% vs. 36.8%; OR 0.32 (95% CI 0.09 – 0.95)] and cervical cancer screening [42.1% vs. 64.2%; OR 0.41 (95% CI 0.19 – 0.87)] compared to sheltered participants; this disparity was not detected for colorectal cancer screening [31.1% vs. 41.5%; OR 0.63 (95% CI 0.38 – 1.05)]. In an exploratory multivariate analysis, active cigarette smoking was associated with a lower likelihood of having up to date colorectal cancer screening (OR 0.57; 95% CI 0.02 – 0.35), while having a PCP was associated with a higher likelihood (OR 3.59; 95% CI 2.08 – 6.19). Regarding barriers to cancer screening, unsheltered participants self-reported experiencing more barriers to completing cancer screenings (58.2% vs. 22%; chi square p < 0.001). Conclusions: Our study shows that disparity in shelter arrangements can influence the likelihood of completing recommended cancer screenings in the unhoused population. We found that among the unhoused population in Providence, RI, unsheltered female participants were less likely to report being up-to-date with breast and cervical cancer screenings recommendations compared to their sheltered counterparts. This study represents a first step to identifying and addressing these disparities.