Disparities in Colorectal Cancer Screening by Time in the US and Race/Ethnicity, 2010-2018

Introduction: Longer time lived in the U.S. has been associated with worse health outcomes, espe-cially preventable diseases, among racially and ethnically diverse groups of foreign-born individuals. This study evaluated the association between time lived in the U.S. and colorectal cancer screening adherence and whether this relationship differed by race and ethnicity.Methods: Data from the National Health Interview Survey for 2010-2018 among adults aged 50-75 years were used. Time in the U.S. was categorized as U.S.-born, foreign-born >15 years, and foreign-born <15 years. Colorectal cancer screening adherence was defined according to U.S. Preventive Services Task Force guidelines. Generalized linear models with Poisson distribution were used to calculate adjusted prevalence ratios and 95% CIs. Analyses were conducted in 2020-2022, were stratified by race and ethnicity, accounted for the complex sampling design, and were weighted to be representative of the U.S. population.Results: Prevalence of colorectal cancer screening adherence was 63% overall, 64% for U.S.-born, 55% for foreign-born >15 years, and 35% for foreign-born <15 years. In fully adjusted models for all individu-als, only foreign-born <15 years had lower adherence than U.S.-born (foreign-born >15 years: prevalence ratio=0.97 [0.95, 1.00], foreign-born <15 years: prevalence ratio=0.79 [0.71, 0.88]). Results differed by race and ethnicity (p-interaction=0.002). In stratified analyses, findings for non-Hispanic White individu-als (foreign-born >15 years: prevalence ratio=1.00 [0.96, 1.04], foreign-born <15 years: prevalence ratio=0.76 [0.58, 0.98]) and non-Hispanic Black individuals (foreign-born >15 years: prevalence ratio=0.94 [0.86, 1.02], foreign-born <15 years: prevalence ratio=0.61 [0.44, 0.85]) were similar to all indi-viduals. Disparities by time in the U.S. were not observed among Hispanic/Latino individuals (foreign-born >15 years: prevalence ratio=0.98 [0.92, 1.04], foreign-born <15 years: prevalence ratio=0.86 [0.74, 1.01]) but persisted among Asian American/Pacific Islander individuals (foreign-born >15 years: preva-lence ratio=0.84 [0.77, 0.93], foreign-born <15 years: prevalence ratio=0.74 [0.60, 0.93]).Conclusions: The relationship between colorectal cancer screening adherence and time in the U.S. varied by race and ethnicity. Culturally and ethnically tailored interventions are needed to improve colorectal cancer screening adherence among foreign-born people, especially among the most recently immigrated individuals. Am J Prev Med 2023;65(1):74-82.& COPY; 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).