Assess whether nativity and duration of US residence were associated with nonadherence to colorectal cancer screening guidelines among US adults aged 45 to 75 years after the 2021 USPSTF screening-age expansion.
Approach:
Design and data: Cross-sectional analysis of 2023 National Health Interview Survey data for 12,016 adults aged 45 to 75 years with no cancer history.
Exposure and outcome: Compared US-born adults with non-US-born adults residing in the US for less than 15 years or 15 years or longer. Nonadherence meant not being current for any guideline-approved screening modality.
Analysis: Survey-weighted modified Poisson regression estimated adjusted risk ratios, accounting for demographic, socioeconomic, and health care access characteristics.
Key Findings:
Weighted screening nonadherence prevalence was 34.5% (95% CI, 33.4%-35.6%).
Compared with US-born adults, non-US-born adults had higher adjusted nonadherence if they had lived in the US for less than 15 years (ARR, 1.25; 95% CI, 1.09-1.43) or 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 greater nonadherence.
Nativity’s relative association with nonadherence was weaker among adults aged 45 to 49 years than among those aged 50 to 75 years, while adjusted absolute differences were broadly comparable.
Interpretation:
After adjustment for measured demographic, socioeconomic, and health care access factors, adults born outside the US had greater screening nonadherence, particularly those residing in the US for less than 15 years. The authors state that expanding screening eligibility alone may not be sufficient to achieve equitable CRC prevention and that additional strategies are needed to address screening barriers among immigrant populations.
Limitations:
Cross-sectional design.
Screening status was self-reported.
Residual confounding and selection related to excluding respondents with missing data are possible.
Some estimates for adults residing in the US for less than 15 years were imprecise.
