ORIGINAL RESEARCH
Isabelle R. Franklin, BA; Rebecca Gambatese, MPH; Mark C. Duggan, MA; Beverly B. Green, MD, MPH; Robert S. Nocon, PhD; Gloria D. Coronado, PhD; Erin E. Hahn, PhD, MPH; Stacey A. Honda, MD, PhD; Kate Koplan, MD, MPH; Theodore R. Levin, MD; Claudia A. Steiner, MD, MPH; Quyen Ngo-Metzger, MD, MPH
Corresponding Author: Isabelle R. Franklin, BA; Kaiser Permanente Bernard J. Tyson School of Medicine
Email: isabelle.r.franklin@kp.org
DOI: 10.3122/jabfm.2023.230497R1
Keywords: Cancer Screening, Colorectal Cancer, Cross-Sectional Studies, Social Determinants of Health, Social Factors
Dates: Submitted: 12-30-2023; Revised: 03-08-2024; Accepted: 03-25-2024
AHEAD OF PRINT: |HTML| |PDF| FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the United States. While patient-reported barriers have been previously described, few studies have analyzed how patients’ social needs affect screening rates.
METHODS: This cross-sectional study includes 3443 Kaiser Permanente (KP) patients ages 50-75 years who completed the 2020 KP National Social Needs Survey. Five social needs categories were assessed: “Financial Strain”, “Housing Instability”, “Transportation Issues”, “Social Isolation”, and “Food Insecurity”. Being up to date on CRC screening was determined from patients’ electronic health records, defined as meeting Healthcare Effectiveness Data and Information (HEDIS) criteria for screening. We used multivariable analyses to explore associations between social needs and completion of colorectal cancer screening in 2020, adjusting for demographic factors.
RESULTS: Among the survey respondents, 2805 (81.5%) were up to date on their colorectal cancer screening. Patients were less likely to be screened if they had severe financial strain (OR 2.1, 95% CI 1.3-3.4), severe social isolation (OR 1.9, 95% CI 1.2-3.2), and severe food insecurity (OR 2.5, 95% CI 1.2-5.3). There was a nonsignificant increase in odds of not being up to date with screening for severe transportation issues (OR 3, 95% CI 0.93-10) and severe housing instability (OR 1.7, 95% CI 0.93-3).
CONCLUSION: Even within a fully insured population with high screening rates, respondents with financial strain, social isolation, and food insecurity had lower odds of being up to date with CRC screening. Future efforts should assess how addressing patients’ social needs could lead to increased CRC screening rates.