Colorectal Cancer Screening and Health-Related Social Needs in a National Sample of US Adults.
Level 4 - case-series / case-control
Cross-sectional survey analysis of nationally representative data
PubMed 41954935 · doi:10.1001/jamanetworkopen.2026.6000
What was done
Researchers analyzed cross-sectional data from 14,528 noninstitutionalized US adults aged 45 to 75 years in the 2023 National Health Interview Survey. They assessed self-reported health-related social needs (HRSNs), including housing instability, food insecurity, transportation barriers, and total count of unmet needs. Using survey-weighted multivariable logistic regression, they calculated adjusted odds ratios (aORs) for being up to date with colorectal cancer (CRC) screening per US Preventive Services Task Force recommendations, overall and across age brackets (45–49, 50–64, and 65–75 years).
What was found
Overall, 63.91% of adults (9,758 participants) were up to date with CRC screening: 31.01% among ages 45–49, 64.24% among ages 50–64, and 80.85% among ages 65–75. Overall, 14.60% (2,158 adults) reported at least 1 unmet HRSN. In adjusted models, lower screening odds were observed for adults with housing instability (aOR, 0.82; 95% CI, 0.67–0.99), transportation barriers (aOR, 0.78; 95% CI, 0.64–0.95), and 1 unmet need (aOR, 0.84; 95% CI, 0.72–0.98). Negative associations were most pronounced in the 50-to-64 age group for housing instability (aOR, 0.77; 95% CI, 0.61–0.97), transportation barriers (aOR, 0.71; 95% CI, 0.56–0.91), and having 1 unmet need (aOR, 0.80; 95% CI, 0.66–0.97).
Why it matters
The study identifies specific social risk factors, particularly housing instability and transportation challenges, that are linked to underutilization of CRC screening, highlighting potential non-clinical targets for public health outreach among middle-aged adults.
Limits
The cross-sectional design precludes causal conclusions. Both CRC screening status and health-related social needs relied on self-report, introducing potential recall and social desirability biases. The dataset was restricted to noninstitutionalized US adults, limiting generalizability to institutionalized or unstably unhoused populations.
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- context Only about 20% of eligible adults aged 45 to 49 are actually obtaining screening colonoscopies.