Cancer Epidemiol Biomarkers Prev

BackgroundThe US Preventive Services Task Force recommends routine screening for colorectal cancer (CRC) for adults 50-75 years. We generated small-area estimates for being current with CRC screening to examine socio-geographic differences among states and counties. To our knowledge, nationwide county-level estimates for CRC screening are rarely presented.MethodsWe used county data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) (n=251,360 adults), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression mixed models. We post-stratified the data with the US census population data to run Monte-Carlo simulations. We generated county-level screening prevalence estimates nationally and by race/ethnicity, mapped the estimates and aggregated them into state- and national estimates. We evaluated internal consistency of our model state-specific estimates with BRFSS direct state estimates using Spearman correlation coefficients.ResultsCorrelation coefficients were 650.95, indicating high internal consistency. We observed substantial variations in current CRC screening estimates among the states and counties within states. State mean estimates ranged from 58.2% in Wyoming to 75.03% in Massachusetts. County mean estimates ranged from 40.11% in Alaska to 79.76% in Florida. Larger county variations were observed in various race/ethnicity groups.ConclusionsState estimates mask county variations. However, both state and county estimates indicate that the country is far behind the \u201c80% by 2018\u201d target.ImpactCounty-modeled estimates help identify variation in CRC screening prevalence in the US and guide education and enhanced screening efforts in areas of need including areas without BRFSS direct-estimates.20182018-09-01T00:00:00ZCC999999/ImCDC/Intramural CDC HHS/United States29500250PMC5836477599