Cross-sectional study of nativity and US residence duration and colorectal cancer screening nonadherence

Colorectal cancer (CRC) remains a leading cause of cancer morbidity and mortality despite being largely preventable through screening. In 2021, the USPSTF lowered the recommended screening initiation age for 50 years to 45 years for adults with average risk. Screening uptake remains suboptimal, particularly among newly eligible adults and populations facing health care access barriers. A cross-sectional study using the 2023 National Health Interview Survey Sample Adult data evaluated the association of nativity and duration of US residence with nonadherence to CRC screening. Adults aged 45 to 75 years without self-reported cancer were included. Among 12 016 adults (mean age 58.8 years, SD 8.5; 50.8% females), screening nonadherence was higher among non-US-born adults residing in the US for less than 15 years (ARR 1.25; p=0.001) and for 15 years or longer (1.14; p=0.004) compared with US-born adults. Lacking a usual source of care (ARR 1.61; p<0.001) and being uninsured (1.47; p<0.001) were also associated with nonadherence. The relative associations between nativity and screening nonadherence were attenuated among adults aged 45 to 49 years compared with those aged 50 to 75 years, whereas adjusted absolute difference were broadly similar between age groups. The authors conclude that strategies are needed for addressing persistent barriers to screening uptake and completion among immigrant populations in the US.