Background:

Racial and ethnic disparities in receipt of recommended colorectal cancer screening exist, however the impact of social determinants of health on such disparities has not been recently studied in a national cohort.

Objective:

The objective of this study was to determine whether social determinants of health attenuate racial disparities in receipt of colorectal cancer screening.

Design:

Cross-sectional telephone survey of self-reported race and ethnicity and up-to-date colorectal cancer screening. Associations between race/ethnicity and colorectal cancer screening were tested before and after adjustment for demographics, behavioral factors, and social determinants of health.

Setting:

This was a nationally representative telephone survey of USA residents in 2018.

Patients:

The patients were USA residents aged 50-75 years.

Main outcome measures:

Up-to-date colorectal cancer screening status, according to 2008 U.S. Preventative Services Task Force recommendations.

Results:

This study included 226,106 respondents aged 50 to 75 years. Prior to adjustment, all minority racial and ethnic groups demonstrated a significantly lower odds of screening compared to non-Hispanic White respondents. After adjustment for demographics, behavioral factors, and social determinants of health, compared to non-Hispanic White respondents, odds of screening was increased among non-Hispanic Black respondents (OR 1.10, p = 0.02); lower but attenuated among Hispanic respondents (OR 0.73, p < 0.001), non-Hispanic American Indian/Alaskan Native respondents (OR 0.85, p = 0.048), and non-Hispanic respondents of other races (OR 0.82, p = 0.01); and lower but not attenuated among non-Hispanic Asian (OR 0.68, p < 0.001) respondents.

Limitations:

Recall bias and participant bias, as well as residual confounding.

Conclusions:

Adjustment for social determinants of health reduced racial and ethnic disparities in colorectal cancer screening among all minority racial and ethnic groups except non-Hispanic Asian individuals; however, other unmeasured confounders likely exist. See Video Abstract at http://links.lww.com/DCR/B977.