Evaluating cancer screening utilization in the U.S. by socioeconomic stress: insights from National Health Interview Survey (NHIS) 2021 data

Purpose We present the findings from an analysis of the National Health Interview Survey (NHIS) 2021 data for colorectal cancer screening prevalence for adults, and breast and cervical cancer screening prevalence for women, with a focus on socioeconomic stress, defined as financial strain due to income, education, and insurance. Methods We used U.S. Preventive Services Task Force (USPSTF) recommendations to determine screening prevalence for breast (women aged 50-74 y), cervical (women aged 21-65 y) and colorectal (adults aged 45-75 y) cancers. We analyzed screening prevalence across socioeconomic stress groups and racial/ethnic groups. Results Screening prevalence declined with increasing socioeconomic stress across all types of cancer. Among individuals with low socioeconomic stress, prevalence was highest: for breast cancer, it ranged from 83.8% to 90.2%; for cervical cancer, from 88.9% to 92.8%; and for colorectal cancer, from 62.2% to 74.6% among females and 51.3% to 76.2% among males. In contrast, individuals under high socioeconomic stress had lower prevalence across all groups: breast cancer ranged from 57.1% to 74.4%, cervical cancer from 63.2% to 64.4%, colorectal cancer among females from 41.0% to 59.0%, and among males from 35.2% to 48.0%. Conclusion Our findings underscore the importance of considering socioeconomic stress when examining cancer screening behaviors.