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Article Title

Predictors of Colorectal Cancer Screening Prior to Implementation of a Large Pragmatic Trial in Federally Qualified Health Care Centers

Publication Date

8-10-2017

Keywords

cancer, demographics, racial/ethnic differences in health and health care, social determinants

Abstract

Background: Colorectal cancer (CRC) screening can prevent unnecessary cancer deaths. Federally qualified health care centers (FQHC) serve a unique patient population that often is not screened. Knowing who in the FQHC environment is getting screened via fecal testing (FIT/FOBT) and via colonoscopy can assist in tailoring intervention to raise rates of CRC screening.

Methods: As part of the STOP CRC study, we examined the associations among patient-level and neighborhood-level characteristics and being up to date with CRC screening guidelines (ie, having had a fecal test in the past year or having had a colonoscopy in the past 10 years). We also examined associations between these factors and being screened with a fecal test only. We derived neighborhood-level characteristics by linking U.S. Census data to zip code information obtained from the electronic health record. We used logistic regression, adjusted for clustering at the health center level, to calculate our associations.

Results: We observed a steady rise in CRC screening rates from 2010 to 2015 (17.7% to 46.8%). In adjusted analysis, factors associated with being up to date with CRC screening overall were: being older, having health insurance, having prior office or emergency room visits, and having other preventive screenings. Among patients who were up to date with CRC screening, factors associated with use of fecal testing were: being younger, speaking a non-English language, being uninsured, having prior office visits, having had a flu shot in past year, and living in a neighborhood with higher unemployment.

Conclusion: Encounter-level variables — such as insurance status, number of office visits in the past year, types of chronic health conditions, and other screenings –– were most often associated with predicting CRC screening, and FIT/FOBT use was more common among typically underscreened populations. Our findings may inform clinic-based efforts to raise rates of CRC screening, especially in the community clinic setting.

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