EP2015 - Socioeconomic Barriers to Colorectal Cancer Screening: Self-Reported Data from an Urban Hospital Serving a Socioeconomically Disadvantaged County in New Jersey

Purpose/Background: Passaic County, NJ, has rising colorectal cancer (CRC) incidence and historically low screening rates. High poverty, limited education, language barriers, and reduced access to care contribute to screening disparities. This study examines socioeconomic and demographic barriers to CRC screening among average-risk adults aged 45-75 presenting to the emergency department at St. Joseph's University Medical Center, an urban safety-net hospital. Identifying modifiable barriers within this underserved population may inform targeted interventions to increase screening uptake.

Methods/Interventions: We conducted a cross-sectional survey study of adults aged 45-75 residing in Passaic County, NJ. Random sampling ensured inclusion of low-income, uninsured, and minority groups. Surveys were administered in-person, available in English and Spanish, with additional language support using a certified medical interpreter. To date, 150 participants completed questions on demographics, socioeconomic factors, and CRC screening history. Bivariate associations between 15 socioeconomic variables and CRC screening status were assessed using Fisher's Exact Test. Multivariate logistic regression identified independent predictors for lack of routine CRC screening. IRB approval was obtained; data were de-identified. Limitations include self-report bias, nonresponse bias, and preliminary sample size.

Results/Outcomes: CRC screening was significantly associated with social exposure to CRC screening (p=0.0003), social exposure to CRC (p=0.0005), family history of CRC (p=0.0126), income unaffected by time off for medical care (p=0.0191), annual household income <$20K (p=0.047), and insurance coverage of CRC screening (p=0.017). Other variables such as education level, employment, and general insurance status were not significantly associated. On multivariate logistic regression, social exposure to CRC screening remained the only independent predictor of routine screening. Data collection is ongoing to strengthen statistical power.

Conclusion/Discussion: Both social and economic factors influence CRC screening behavior in this socioeconomically disadvantaged urban population. Social exposure (i.e. knowing someone who has undergone CRC screening) appears to be the strongest driver of screening uptake, underscoring the importance of community and peer influence. Financial security related to time off work and insurance coverage of screening also affect access. These findings highlight the need for culturally tailored, and socially driven interventions to improve CRC screening rates. Ongoing data collection will help refine these observations and guide the development of culturally responsive strategies to reduce screening disparities.

Fisher's Exact Test Analysis
Bivariate associations between 15 socioeconomic variables and CRC screening status assessed using Fisher's Exact Test. Findings show that CRC screening was significantly associated with social exposure to CRC screening (p=0.0003), social exposure to CRC (p=0.0005), family history of CRC (p=0.0126), income unaffected by time off for medical care (p=0.0191), annual household income <$20K (p=0.047), and insurance coverage of CRC screening (p=0.017).
Multivariate Logistic Regression Analysis
Multivariate logistic regression analysis showing that social exposure to CRC screening remained the only independent predictor of routine screening