Predictors of stool deoxyribonucleic acid test use in the United States: Implications for outreach to under-resourced populations.

OBJECTIVE: Although colorectal cancer screening (CRCS) is a public health priority, uptake is suboptimal in under-resourced groups. Noninvasive modalities, including stool deoxyribonucleic acid (sDNA) testing, may mitigate economic, geographic, cultural, or impairment-related barriers to CRCS. We assessed use of sDNA testing and other CRCS modalities in U.S. residents, comparing subgroups defined by several social determinants of health (SDOH).

METHODS: A nationally representative sample of community-dwelling respondents aged 50-75 years self-reported use of CRCS modalities in the 2020 Behavioral Risk Factor Surveillance System Survey. Statistical analyses assessed up-to-date screening status and choice of modality in the recommended screening interval.

RESULTS: Of 179,833 sampled respondents, 60.8% reported colonoscopy, 5.7% sDNA testing, 5.5% another modality. The rate of up-to-date screening was 72.0% overall and negatively associated with Hispanic ethnicity (63.6%), lower educational and annual income levels (e.g., <high school, 63.7%, <$20,000, 67.2%), and cost-related difficulty accessing physician care (57.4%; all p < 0.001) but not with Black non-Hispanic race/ethnicity (74.6%) or sensory, cognitive, or physical impairments (73.1%-73.9%). Choice of sDNA instead of colonoscopy was made by 8.5% overall and was more common in the same SDOH groups (Hispanic ethnicity, 17.7%; <high school, 17.4%; <$20,000, 16.8%; cost-related difficulty accessing care, 12.0%); Black non-Hispanic race/ethnicity (11.6%); and impairments (sensory, 12.0%; other cognitive or physical, 12.9%).

CONCLUSIONS: Under-resourced persons were more likely than better-resourced persons to access sDNA testing, possibly offsetting screening barriers in some groups. Findings suggest opportunities to increase CRCS with heightened communication about sDNA testing to those who may experience difficulty accessing other modalities.