Reducing Disparities in Colorectal Cancer Screening among Low-Income Non-Elderly Adults in the United States

Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer deaths in the U.S. Despite the high prevalence of CRC, incidence and mortality rates of CRC have been steadily decreasing since early 2000s as it is one of few screening-amenable cancers. However, disparities in CRC screening persist among low-income non-elderly adults as they face a number of socioeconomic barriers to timely access to care. Chapter one assesses temporal trends in CRC screening services utilization among low-income non-elderly adults using national survey data for 2003 – 2018. We observe an overall increasing trend in receipt of any CRC screening and visual tests while an unchanging trend for stool tests during this period. However, the proportion of low-income non-elderly adults receiving any CRC screening remained lower than the national average in 2018. Our study expands the current knowledge of patterns in CRC screening services among low-income non-elderly adults in the U.S. Chapter two identifies predictors of CRC testing among Pennsylvania Medicaid enrollees using Medicaid administrative claims data for 2015 – 2019. Being male, being Hispanic, having chronic conditions, and using primary care services are positively associated with CRC tests among Medicaid enrollees while being older is negatively associated with receiving CRC tests. With a recent increase in incidence of CRC among younger adults, our findings can inform state Medicaid agencies to improve quality of service and overall health status among the populations that they serve. Chapter three examines v multilevel factors related to CRC screening, including expanded Medicaid coverage under the ACA and improved care delivery with the Colorectal Cancer Control Program (CRCCP) and interactions between these two policies using multi-state secondary survey data for 2003 – 2018. We found no significant systematic impacts of the ACA and CRCCP on lifetime CRC screening uptake. Future research should consider the complex nature of decision-making processes for CRC screening use among heterogenous populations of low-income non-elderly adults in the U.S. The findings of this dissertation will provide insights into the effectiveness of policies and programs developed to reduce disparities in cancer prevention and detection and help inform future initiatives