Geographic and Ethnic Disparities Among Colorectal Cancer Screening Rates Before and During COVID-19: A Retrospective Study of the National Health Interview Survey

Introduction: Disparities in colorectal cancer screening among Africans have been reported since the early 1990s due to a multitude of reasons including limited access to screening, low participation, structural racism and socioeconomic conditions. This may have been further exacerbated by the COVID-19 pandemic. The study aims to evaluate the effects of the COVID-19 pandemic on colorectal cancer screening amongst African Americans during 2020 and 2021. Methods: We performed a retrospective study of the National Health Interview Survey (NHIS) to compare colorectal cancer screening responses before the pandemic in 2019 and during the pandemic in 2021. The primary outcome was the rates of received colorectal cancer screening amongst geographic locations and the secondary outcome was ethnic disparities in the type of screening and costs between African American and White patients. Statistical analysis was performed using JMP Pro (version 17.0.0, SAS Institute Inc., Cary NC). Results: A total of 61,479 adults responded to the survey in 2019 and 2021 combined. A total of 34,046 (55.38%) of the respondents were aged 50 and over and most of the patients were female (54.27%); 75.14% identified as White and 11.18% as African American. Of the patients 50 years and older, the overall cancer screening rate was 70.85%, with 70.90% in 2019 and 70.81% in 2021. A total of 70% of African American patients underwent colonoscopy compared with 72.40% of White patients, P < 0.001. 85.10% of African American patients reported colonoscopy as part of their routine exam compared with 79.61% of White patients, P < 0.001, and 70.65% of African Americans had the total cost of colonoscopy covered while 58.73% of White patients had the full cost covered, P < 0.001. African Americans had a higher rate of colorectal cancer, 10.40% compared with 5.53% for White patients, p < 0.001, and an earlier age of diagnosis 58.98 years compared with 63.37 years for White patients, P = .01. Conclusion: Our study demonstrates that African Americans have similar colon cancer screening rates compared with White patients. However, twice the percentage of African Americans were diagnosed with colon cancer compared with White patients. Given the difference of 2.40% colon cancer screening between African Americans and White patients, there were no major racial disparities and no differences in rates before and during COVID-19. Pragmatic clinical trials are needed to further evaluate the predictors for higher rate of colon cancer diagnosis in African Americans.