Persistent Poverty, Rural Location, and Racial Segregation Are Factors in Colorectal Cancer Screening in Low-Income and Uninsured Populations.

PURPOSE

This study aimed to investigate the correlation between geographical factors, including rurality, persistent poverty counties, racial residential segregation, and adherence to colorectal cancer (CRC) screening among low-income uninsured and underinsured individuals in Texas.

METHODS

Utilizing retrospective survey data collected by the A&M Texas Cancer Screening program from 2011 to 2022, linear mixed-effects models were employed. The models examined CRC screening adherence within the recommended time frame as the primary outcome, with geographical county-level characteristics (rurality, racial residential segregation, and persistent poverty) as the main predictors, controlling for other sociodemographic variables.

FINDINGS

The linear mixed-effects analysis revealed that individuals residing in counties characterized by high racial residential segregation (OR = 0.54, 95% CI = 0.36-0.79) or persistent poverty (OR = 0.65, 95% CI = 0.45-0.92) were less likely to self-report having undergone any type of CRC screening within the recommended time frame compared to those in counties with lower racial residential segregation and non-persistent poverty. Conversely, residents of rural counties were more likely to report being up to date with CRC screening compared to their urban counterparts (OR = 1.8, 95% CI = 1.27-2.55).

CONCLUSIONS

The findings underscore the need for more targeted CRC screening promotion strategies tailored to low-income, uninsured populations residing in disadvantaged areas such as rural and persistent poverty counties, as well as those characterized by high racial residential segregation.