Factors associated with colorectal cancer screening among U.S. adults: A cross-sectional study using NHIS 2023 data

Introduction: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the USA. Although early detection via screening significantly reduces morbidity and mortality, national uptake rates remain suboptimal, particularly among underserved populations. Understanding the multifaceted factors influencing CRC screening adherence is essential for guiding targeted public health interventions. Objective: This study used a nationally representative sample to identify demographic, socioeconomic, and behavioral factors associated with CRC screening adherence among U.S. adults aged 45-75 years. Methods: A cross-sectional analysis was conducted using the 2023 national health interview survey (NHIS) data. Adults aged 45-75 years who reported CRC screening history were included. The primary outcome was up-to-date screening per U.S. Preventive Services Task Force guidelines. Independent variables were guided by Andersen and Davidson’s behavioral model of health services use and included demographic characteristics, socioeconomic status, and healthcare access. Multivariable logistic regression analyses were conducted using weighted survey procedures. Results: The study showed that 68.2% of the adults were up-to-date with CRC screening. Screening rates increased with age and education and were higher among individuals with health insurance and a regular source of care. Compared to non-Hispanic whites, minority groups, particularly Hispanic, non-Hispanic Black, and non-Hispanic Other, exhibited lower screening rates. Access to care, including insurance coverage and a usual care provider, emerged as the strongest predictors of adherence. Individuals who lacked U.S. citizenship, insurance, or faced transportation and cost-related barriers were significantly less likely to be screened. Conclusion: Disparities in CRC screening persist, especially among younger adults, racial/ethnic minorities, and the socioeconomically disadvantaged. Expanding insurance coverage and strengthening provider engagement are key drivers to improve screening uptake.