Trends and Factors Associated with Fecal Occult Blood Test Utilization among Hispanic Adults in Puerto Rico and the United States: BRFSS 2012–2020

Abstract

Identifying factors associated with colorectal cancer (CRC) screening utilization is important to guide CRC prevention and control programs. We evaluated trends and factors associated with previous-year fecal occult blood test (FOBT) use among Hispanic adults living in Puerto Rico and the US mainland. Using data from the Behavioral Risk Factor Surveillance System (2012-2020), trends in FOBT use were analyzed using joinpoint regression to estimate annual percentage change (APC). Logistic regression stratified by location identified factors associated with FOBT use. FOBT was more common among Hispanic adults aged 50-75 years living in Puerto Rico than in the US mainland [Puerto Rico: 20.5%[2012] to 45.6%[2020], APC=11.4%; US mainland: 9.9%[2012] to 16.7%[2020], APC=5.9%]. Factors inversely associated with FOBT use were similar in Puerto Rico and the US mainland, including lack of health insurance, not having a personal doctor, having a checkup >12 months ago, and not being able to see a doctor due to cost, as were factors associated with higher FOBT use, including older age, retirement or having two or more chronic diseases. Among Hispanics living in the US mainland, lack of exercise and less education were inversely associated with FOBT. Factors related to poor access to healthcare were associated with lower use of FOBT among Hispanics. Efforts to improve CRC screening in Hispanics are necessary to address health disparities across the CRC care continuum.

Delays in Colorectal Cancer Screening for Latino Patients: The Role of Immigrant Healthcare in Stemming the Rising Global Incidence of Colorectal Cancer

“…Accordingly, large differences in Latino screening uptake between states are likely driven by different healthcare-related policies, though differing makeups of Latino subpopulations could contribute as well [54]. Low income, no recent physician visits, or no high school education were associated with decreased CRC screening in US Latinos [51,49,53,55], as well as living in the USA for less than 15 years [49] and having less "acculturation" [56]. Compared to second-and third-generation Latinos (those who were born in the United States or who have spent a significant amount of their lives in the United States), first-generation Latinos (those who were born outside the United States) generally have lower rates of CRC screening uptake [49,51,57], though the effect of US nativity may vary by Latino subgroup.…”