Franklin on the Effects of Social Determinants of Health on CRC Screening

Isabelle Franklin, medical student, Kaiser Permanente Bernard J. Tyson School of Medicine, discusses the effects of social determinants of health on rates of colorectal cancer (CRC) screening.

At the 2023 ASCO Annual Meeting, investigators presented data from a cross-sectional study of 3,443 patients between 50 and 74 years of age, from Kaiser Permanente who completed the Kaiser Permanente National Social Needs Survey in 2020. When overlaying social needs and screening completion data, a significant correlation was found between 3 of 5 social needs and lower rates of screening, Franklin begins. Data showed that patients with financial strain were more likely to not undergo screening (26%) compared with those without sever financial strain (17%; P < .001). Additionally, those who reported social isolation were less likely to be screened (24%) vs those who did not (18%; P =.011), and patients who reported severe food insecurity were more likely to not be screened (24%) vs those without severe food insecurity (18%; P = .005). Notably, 25% of patients who reported severe housing instability did not receive CRC screening vs 18% of patients without severe housing instability (P = .005), and 35% of patients with severe transportation issues did not undergo screening compared with 18% of patients without transportation issues (P = .003). That data from housing instability and transportation issues bordered on statistical significance, Franklin says.

The study included data from patients across all regions within Kaiser Permanente health-care system, Franklin continues. Moreover, each of the 7 regions that were evaluated had slightly different individual results regarding which of the 5 social needs were significant when they were examined in isolation, Franklin adds. For example, although correlative data for transportation and housing issues were not statistically significant for the overall study, they were significant when looked at in some regions specifically, she says. Therefore, it is important to understand that all these social needs could potentially play a role in CRC screening rates, and each of them could represent an area to address to improve rates of screening, Franklin emphasizes.

Franklin notes that since these results were taken from patients within the Kaiser Permanente health-care system, all patients were insured. Although the assumption could be that having health insurance negates problems associated with screening rates and other issues, disparities can still persist for these patients, Franklin concludes.