Giurini Lauren, Gangnon Ronald E, Trentham-Dietz Amy, Zheng Wei, Lipworth Loren, Murff Harvey J, Steinwandel Mark, Weiss Jennifer, Warren Andersen Shaneda
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.
Cancer Prev Res (Phila). 2025 Jun 2;18(6):355-363. doi: 10.1158/1940-6207.CAPR-24-0541.
Colorectal cancer is highly preventable with timely screening, but screening modalities are widely underused, especially among those of low individual-level socioeconomic status (SES). In addition to individual-level SES, neighborhood-level SES may also play a role in colorectal cancer screening completion through less geographic access to health care, transportation, and community knowledge of and support for screenings. We investigated the associations of neighborhood SES using a census tract-level measure of social and economic conditions with the uptake of colonoscopy and stool-based testing. We utilized data from the Southern Community Cohort Study, a large, prospective study of English-speaking adults ages 40 to 79 from the southeastern United States with 65% of participants identifying as non-Hispanic Black and 53% having annual household income <$15,000. Neighborhood SES was measured via a neighborhood deprivation index compiled from principal component analysis of 11 census-tract variables in the domains of education, employment, occupation, and poverty; screening was self-reported at the baseline interview (2002-2009) and follow-up interview (2008-2012). We found that participants residing in the lowest SES areas had lower odds of ever undergoing colonoscopy (ORQ5vsQ1 = 0.75; 95% confidence interval, 0.68-0.82) or stool-based colorectal cancer testing (ORQ5vsQ1 = 0.71; 95% confidence interval, 0.63-0.80) while adjusting for individual-level SES factors. Associations were consistent between neighborhood SES and screening in subgroups defined by race, sex, household income, insurance, or education (P > 0.20 for all interaction tests). Our findings suggest that barriers to screening exist at the neighborhood level and that residents of lower SES neighborhoods may experience more barriers to screening using colonoscopy and stool-based modalities. Prevention Relevance: This study presents evidence that persons living in lower SES neighborhoods use colorectal cancer screening modalities at lower rates. Screening is highly preventive of colorectal cancer, but it has limited benefit if it cannot be utilized. Addressing neighborhood-level barriers to screening may improve socioeconomic disparities in colorectal cancer.
结直肠癌通过及时筛查是高度可预防的，但筛查方式的使用普遍不足，尤其是在个人社会经济地位（SES）较低的人群中。除了个人层面的SES外，邻里层面的SES也可能通过医疗保健的地理可及性较低、交通不便以及社区对筛查的了解和支持等因素，在结直肠癌筛查完成情况中发挥作用。我们使用人口普查区层面的社会和经济状况指标，调查了邻里SES与结肠镜检查和粪便检测的接受情况之间的关联。我们利用了南方社区队列研究的数据，这是一项针对美国东南部40至79岁讲英语成年人的大型前瞻性研究，65%的参与者为非西班牙裔黑人，53%的家庭年收入低于15,000美元。邻里SES通过邻里剥夺指数来衡量，该指数由对教育、就业、职业和贫困领域的11个人口普查区变量进行主成分分析编制而成；筛查情况在基线访谈（2002 - 2009年）和随访访谈（2008 - 2012年）中通过自我报告获得。我们发现，在调整个人层面的SES因素后，居住在SES最低地区的参与者接受结肠镜检查（ORQ5vsQ1 = 0.75；95%置信区间，0.68 - 0.82）或粪便基结直肠癌检测（ORQ5vsQ1 = 0.71；95%置信区间，0.63 - 0.80）的几率较低。在按种族、性别、家庭收入、保险或教育定义的亚组中，邻里SES与筛查之间的关联是一致的（所有交互作用检验的P>0.20）。我们的研究结果表明，筛查障碍在邻里层面存在，且SES较低邻里的居民在使用结肠镜检查和粪便基方式进行筛查时可能会遇到更多障碍。预防相关性：本研究提供了证据表明，生活在SES较低邻里的人群使用结直肠癌筛查方式的比例较低。筛查对结直肠癌具有高度预防作用，但如果无法利用，其益处有限。解决邻里层面的筛查障碍可能会改善结直肠癌方面的社会经济差异。
