What are the contextual risk factors for low colorectal cancer screening uptake in El Paso County, Texas? Spatial cross-sectional analysis

Colorectal Cancer

BMJ Open. 2020 Oct 10;10(10):e038342. doi: 10.1136/bmjopen-2020-038342.


OBJECTIVE: This study examines the geographical and socioeconomic factors associated with uptake of colorectal cancer (CRC) screening (colonoscopies or faecal immunochemical test (FIT) testing).

DESIGN: Secondary data analysis.

SETTING: The Against Colorectal Cancer in our Community (ACCION) programme was implemented in El Paso County, Texas, to increase screening rates among the uninsured and underinsured.

PARTICIPANTS: We successfully geocoded 5777 who were offered a free colonoscopy or FIT testing kit.

PRIMARY OUTCOME MEASURE: Census-tract CRC screening uptake average.

RESULTS: Medicare recipient mortality (β=0.409, p-value=0.049) and % 65 years or older (β=-0.577, p value=0.000) were significant census tract contextual factors that were associated with the prevalence of CRC screening uptake in the geographically weighted Poisson regression. Neither Latino ethnicity nor immigrant concentration were significant predictors of CRC screening uptake in the ACCION programme. Hot spot analysis demonstrated that there was a significant low-value cluster in South Central El Paso. There was a similar hot spot for % 65 years or older in this same area, suggesting that uptake was lowest in an area that had the highest concentration of older adults.

CONCLUSION: The results from this study revealed not only feasibility of hot spot analysis but also its utility in geographically tracking successful CRC screening uptake in cancer prevention and intervention programmes.