Clinical Scorecard: Nativity and Length of US Residence in Relation to Nonadherence to Colorectal Cancer Screening
At a Glance
Category
Detail
Condition
Nonadherence to colorectal cancer screening recommendations among US adults aged 45 to 75 years without a history of cancer.
Key Mechanisms
The study examined nativity and duration of US residence as factors associated with screening nonadherence, accounting for demographic, socioeconomic, and health care access characteristics.
Target Population
US adults aged 45 to 75 years with no history of cancer, including US-born adults and non-US-born adults grouped by less than 15 or at least 15 years of US residence.
Care Setting
US population-based screening context, assessed using the 2023 National Health Interview Survey; the study identifies associations and does not evaluate a specific care setting.
Key Highlights
Weighted screening nonadherence prevalence was 34.5% (95% CI, 33.4%-35.6%).
Compared with US-born adults, adjusted nonadherence was higher among non-US-born adults residing in the US for less than 15 years (ARR, 1.25; 95% CI, 1.09-1.43) and for 15 years or longer (ARR, 1.14; 95% CI, 1.04-1.24).
Lacking a usual source of care (ARR, 1.61; 95% CI, 1.50-1.72) and lacking insurance (ARR, 1.47; 95% CI, 1.35-1.60) were associated with nonadherence.
Among non-US-born adults residing in the US for less than 15 years, adjusted nonadherence values were highest in the reported categories for those without insurance, those lacking a usual source of care, and adults aged 45 to 49 years.
The cross-sectional analysis relied on self-reported screening and noted potential residual confounding, selection related to missing data, and imprecise estimates for some recent residents.
Guideline-Based Recommendations
Diagnosis
Management
The authors state that additional strategies are required to address obstacles to screening uptake and completion among immigrant populations.
Monitoring & Follow-up
The study assessed whether participants were current with at least one USPSTF guideline-approved screening modality within its specified interval.
Risks
The study reports associations with screening nonadherence, not causal effects; its cross-sectional design limits causal interpretation.
Self-reported screening, potential residual confounding, possible selection related to missing data, and imprecise estimates for some adults residing in the US for less than 15 years were limitations.
Patient & Prescribing Data
The analysis included 12,016 adults aged 45 to 75 years without a cancer history, representing an estimated 95,399,898 US adults.
No treatment or prescribing intervention was evaluated. The study assessed screening nonadherence and found higher adjusted nonadherence among non-US-born adults and among adults without insurance or a usual source of care.
Clinical Best Practices
The article describes USPSTF screening eligibility for average-risk adults as beginning at age 45 after the 2021 recommendation change.
Assess whether eligible adults are current with at least one guideline-approved colorectal cancer screening modality within its recommended interval.
The study identifies insurance status and access to a usual source of care as factors associated with screening nonadherence.
