Abstract C161: Bridging screening gaps: The role of annual healthcare utilization and rurality in colorectal cancer screening

Abstract

Colorectal cancer (CRC) is the third most diagnosed cancer and the second leading cause of cancer mortality in the United States (U.S.). Maintaining up-to-date CRC screening is a key factor in the early detection of CRC, and annual healthcare utilization may facilitate this process by increasing opportunities to engage with healthcare providers that support adherence to screening practices. However, individuals living in rural areas are less likely to participate in screening uptake due to limited access to healthcare resources. Although prior research has independently linked healthcare utilization and rurality to CRC screening use, little is known about how these factors interact. Thus, we evaluated the relationship among annual healthcare utilization, rurality, and CRC screening adherence in a nationally representative sample of U.S. adults. A cross-sectional analysis of the 2023 National Health Interview Survey was performed among screening-eligible adults aged 45-74 years. Our primary outcome was up-to-date CRC screening [colonoscopy, sigmoidoscopy, or Fecal Occult Blood Test (FOBT)] according to the 2021 U.S. Preventive Services Task Force (USPSTF) recommendations. The exposures of interest were annual healthcare utilization (yes or no) and four-level rurality (large central metro, large fringe metro, small/medium metro, or rural). Weighted multivariable logistic regression models were applied while adjusting for sociodemographic characteristics and health-related factors. Of the 14,138 eligible respondents, 63.3% were up to date with CRC screening. Among those who were up to date with screening, 96.0% reported annual healthcare utilization (p < 0.001), and 30.7% resided in small/medium metro areas (p = 0.022). In adjusted analyses, participants who reported annual healthcare utilization were nearly five times more likely to be up to date with CRC screening than those who did not report annual healthcare utilization (AOR, 4.55; 95% CI, 4.00-5.26). Adults living in rural areas were 22% less likely to be up to date with CRC screening than those living in large central metro areas (AOR, 0.78; 95% CI, 0.67-0.89). Our stratified analysis showed that adults who had an annual healthcare use had almost 5 times increased odds of CRC screening adherence than those without regardless of rurality (large central metro: AOR, 4.55; 95% CI, 3.33-5.88; large fringe metro: AOR, 4.76; 95% CI, 3.44-6.67; small/medium metro: AOR, 4.76; 95% CI, 3.85-6.25; rural: AOR, 4.55;95% CI, 2.50-7.14). Although rural residence was associated with lower CRC screening adherence, annual healthcare utilization emerged as the strongest predictor of being up to date with CRC screening, irrespective of rurality. Enhancing patient-provider communication and provider referrals for CRC screening during annual healthcare visits and addressing barriers faced by rural residents may improve screening adherence among screening-eligible adults in these vulnerable populations. Keywords: Annual healthcare utilization, rurality, colorectal cancer screening Tumi Adaramola, Elinita Pollard, Lorriane Odhiambo, Brian Armstrong, Meng-Han Tsai. Bridging screening gaps: The role of annual healthcare utilization and rurality in colorectal cancer screening [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr C161.