Association Between Race, Ethnicity, and Sex With Colorectal Cancer Screening Use Among US Adults With and Without Self-Reported Depressive Disorders, Behavioral Risk Factor Surveillance System, 2022

Introduction: Colorectal cancer (CRC) is the third leading cause of cancer death in men and the fourth in women in the US. Racial, ethnic, and sex disparities persist, and people with depressive disorders may delay or skip CRC screening, contributing to later-stage diagnosis and worse outcomes. We examined the association between sex, race, ethnicity, and CRC screening by depression history. Methods: We analyzed 2022 Behavioral Risk Factor Surveillance System data for adults aged 45 to 74 years (n = 222,601), classifying CRC screening status as up to date or not up to date/never screened. The main predictors were sex, race, and ethnicity (eg, non-Hispanic Black women) and self-reported depression. We used Poisson regression to estimate adjusted prevalence ratios (aPRs). Results: The weighted sample represented approximately 108 million United States adults aged 45 to 74 years. People with depression were slightly more likely to be up to date with CRC screening (aPR = 1.05; 95% CI, 1.04-1.07) compared with those without depression. Asian (aPR = 0.77; 95% CI, 0.72-0.83), American Indian or Alaska Native (aPR = 0.81; 95% CI, 0.75-0.88), and Hispanic (aPR = 0.83; 95% CI, 0.80-0.86) people were less likely to be up to date compared with White people. After adjusting for confounders, we found that depression was associated with increased screening only among White women, who were 4% more likely to be up to date (aPR = 1.04; 95% CI, 1.01-1.07) than White men with depression. Conclusion: Outreach programs should aim to increase awareness of and accessibility to CRC screening among people who are at high-risk for CRC, such as Hispanic and Asian populations. More research is needed to better understand how depression and its symptoms influence CRC screening use.