EP280 - Impact of Sociodemographic Factors on FIT Completion in North Philadelphia

Purpose/Background: Although national colorectal cancer (CRC) screening rates have improved over the last two decades, local disparities persist in economically disadvantaged urban areas. In North Philadelphia, neighborhood-level socioeconomic and demographic factors may impact both completion of fecal immunochemical tests (FIT) and the results of FIT testing. The ACCESS (Advancing Colorectal Cancer Equity through Systematic Screening) initiative is a hospital-based program that distributed free FIT kits to patients in underserved areas in North Philadelphia to address screening disparities. This sub-analysis of the ACCESS initiative examines geographic and demographic variation in FIT completion and FIT results across ZIP codes in North Philadelphia. By integrating U.S. Census data-including poverty, employment, rented housing, and primary language-we aim to identify potential sociodemographic disparities in the CRC screening cascade and inform targeted interventions.

Methods/Interventions: We performed a sub-analysis of data collected through the ACCESS initiative. Each participant's ZIP code was obtained at the time of FIT kit distribution. FIT return status (yes/no) and result of completed FIT kit (positive/negative) was recorded for each participant. We identified thirteen ZIP codes that are served by the hospital home to the ACCESS initiative, and excluded all participants outside of these thirteen ZIP codes. Utilizing US Census Data, we recorded the rates of poverty, employment, rented housing, and primary Spanish-speakers for each ZIP code. The ZIP codes were then stratified based on categorical groupings for each factor.

A Chi-square test was performed to assess for differences between rates of FIT completion between each stratified grouping for each separate sociodemographic variable. Fisher's exact test and Fisher-Freeman-Halton tests were performed to assess differences between rates of positive FIT tests between sociodemographic categorical groupings.

Results/Outcomes: The average FIT completion rate among all poverty levels was 46.2%. There were no significant differences between rates of FIT completion by poverty level (p=0.71), employment rate (p=0.47), percent of housing occupied by renters (p=0.50), or percent of the population identifying as a primary Spanish-speaker (p=0.33).

There were no significant differences between rates of rates of positive FIT tests by poverty level (p=0.60),employment rate (p=0.38), percent of housing occupied by renters (p=0.77), or percent of the population identifying as a primary Spanish-speaker (p=0.55).

Conclusion/Discussion: This subanalysis of the ACCESS initiative demonstrated no significant difference in FIT test completion rates or rates of positive FIT results when comparing levels of poverty, employment, rented-housing, or primary Spanish-speakers within the North Philadelphia community. Response rates were comparable to other studies in the literature looking at FIT as a CRC screening method. The results are limited by sample size and the limitations inherent to using census data to extrapolate conclusions on social determinants of health. However, they suggest the success that such initiatives can have in helping patients receive preventative colorectal cancer screening who otherwise might encounter barriers to care.

Rates of FIT Completion and FIT positive results by variable