Abstract
Objectives
To assess the racial and sociodemographic distribution of colorectal cancer (CRC) screening uptake in Canada, identify disparities, and evaluate the potential predictors and barriers to CRC screening.
Methods
Data from the 2017 cycle of the Canadian Community Health Survey (CCHS) were analyzed, focusing on individuals aged 50–74 years. CRC screening participation rates were evaluated at both national and provincial levels and across various sociodemographic characteristics. Multivariable logistic regression models were employed to identify predictors and barriers to CRC screening.
Results
Of the 56,950 respondents to the 2017 CCHS, 41.7% (n = 23,727) were between 50 and 74 years of age. The overall CRC screening participation rate was 59.8%, with provinces like Alberta and Manitoba achieving rates of 65.7% and 66.5%, respectively. Significant disparities were observed across socioeconomic, geographical, and racial or ethnic groups. Notably, older adults [AOR 2.41, 95% CI 2.06‒2.83], higher income earners [AOR 1.99, 95% CI 1.77‒2.24], and non-smokers [AOR 1.76, 95% CI 1.55‒2.0] had higher odds of screening, while immigrants and minority ethnic groups, especially South-East Asians [AOR 0.48, 95% CI 0.29‒0.78] and South Asians [AOR 0.65, 95% CI 0.44‒0.95], had lower odds of being up to date with CRC screening. A significant portion of unscreened individuals cited their healthcare provider’s perception of the test as unnecessary.
Conclusion
While there is promising progress in CRC screening participation rates across Canada, significant disparities persist. Addressing these disparities is crucial for public health. Efforts should focus on enhancing public awareness, facilitating accessibility, and ensuring cultural appropriateness of CRC screening initiatives.
Résumé
Objectifs
Évaluer la distribution raciale et sociodémographique de la participation au dépistage du cancer colorectal (CCR) au Canada, identifier les disparités et évaluer les potentiels prédicteurs et obstacles au dépistage du CCR.
Méthodes
Les données du cycle 2017 de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) ont été analysées, en se concentrant sur les individus âgés de 50 à 74 ans. Les taux de participation au dépistage du CCR ont été évalués à la fois au niveau national et provincial et selon diverses caractéristiques sociodémographiques. Des modèles de régression logistique multivariée ont été utilisés pour identifier les prédicteurs et les obstacles au dépistage du CCR.
Résultats
Sur les 56 950 répondants à l’ESCC 2017, 41,7% (n = 23 727) étaient âgés de 50 à 74 ans. Le taux global de participation au dépistage du CCR était de 59,8%, des provinces comme l’Alberta et le Manitoba atteignant des taux de 65,7% et 66,5% respectivement. Des disparités significatives ont été observées selon les groupes socioéconomiques, géographiques et raciaux ou ethniques. Notamment, les personnes âgées [AOR 2,41, IC 95% 2,06‒2,83], les personnes à revenu élevé [AOR 1,99 IC 95% 1,77‒2,24] et les non-fumeurs [AOR 1,76, IC 95% 1,55‒2,0] avaient des chances plus élevées de dépistage, tandis que les immigrants et les groupes ethniques minoritaires, en particulier les Asiatiques du Sud-Est [AOR 0,48, IC 95% 0,29‒0,78] et les Asiatiques du Sud [AOR 0,65, IC 95% 0,44‒0,95] avaient moins de chances d’être à jour avec le dépistage du CCR. Une part significative des individus non dépistés a cité la perception de leur prestataire de soins de santé selon laquelle le test était inutile.
Conclusion
Bien qu’il y ait une progression prometteuse des taux de participation au dépistage du CCR au Canada, des disparités significatives persistent. Il est crucial pour la santé publique de s’attaquer à ces disparités. Les efforts devraient se concentrer sur l’amélioration de la sensibilisation du public, la facilitation de l’accessibilité et la garantie de l’adéquation culturelle des initiatives de dépistage du CCR.
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Availability of data and materials
Data from the Canadian Community Health Survey (CCHS) are available in the Research Data Centres (RDC) in universities across Canada for researchers who meet the criteria for access to confidential data. Statistical analyses were conducted at the MUN-RDC.
Code availability
SAS syntax files are available pending vetting from RDC Analysts.
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Funding
Adefemi is a trainee in the Cancer Research Training Program (CRTP) of the Beatrice Hunter Cancer Research Institute, with funds generously provided by the Canadian Cancer Society’s JD Irving, Limited—Excellence in Cancer Research Fund. Adefemi was also a recipient of the Aging Research Centre-Newfoundland and Labrador (ARC-NL) Graduate Fellowships.
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Adefemi conceived and designed this study with guidance and supervision from Wang, Knight, and Zhu. All analyses and manuscript writing by Adefemi. Wang and Zhu contributed to the analyses, interpretations of the results, and review of manuscript drafts. Knight contributed to design of the study and review of manuscript drafts. All authors have reviewed the final version of the manuscript and have agreed to its publication.
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Accessing CCHS data at the secured Research Data Centre (RDC) requires extensive checks, review, and vetting by Statistics Canada; as a result, this study did not require approval from the Health Research Ethics Board (HREB) of NL—Memorial University.
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Beatrice Hunter Cancer Research Institute’s Cancer Research Training Program (CRTP) Awards 2022–2023—awards paid as bi-weekly stipends, Aging Research Council of Newfoundland and Labrador (ARC-NL) Doctoral Fellowship 2021–2022, and Statistics Canada—Research Data Centre (RDCs) access to CCHS master files. All authors declare no potential conflicts of interest.
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Adefemi, K., Knight, J.C., Zhu, Y. et al. Racial and sociodemographic distribution of colorectal cancer screening in Canada: A cross-sectional study. Can J Public Health (2024). https://doi.org/10.17269/s41997-024-00859-9
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DOI: https://doi.org/10.17269/s41997-024-00859-9
Keywords
- Colorectal cancer screening
- Health disparities
- Socioeconomic factors
- Health literacy
- Healthcare provider communication
- Canadian Community Health Survey