Abstract C144: The association between social determinants of health and cancer screening: Cross-sectional survey results from the National Health Interview Survey

Abstract Purpose: Social determinants of health (SDOH) have been associated with reduced access to preventive health services. There is limited data about the impact of SDOH within cancer screening settings. Our study evaluated the association between SDOH and breast and colorectal cancer screening using nationally representative cross sectional survey data. Methods: Eligible survey respondents in the 2023 National Health Interview Survey (NHIS) without history of cancer were included. Exposures were assessed based upon responses to survey questions were mapped to CDC defined SDOH domains assessing food security, transportation, internet access, housing, education, employment, and health insurance. Primary outcomes included receipt of breast and colorectal cancer screening as defined by recent USPSTF guidelines. Multiple variable logistic regression analyses were conducted to evaluate the association between social determinants of health and cancer screening, adjusted for potential confounders and accounting for complex survey design features. Results: For breast cancer screening, 8,392 weighted female survey respondents met inclusion criteria of whom 74.6% reported mammography screening within the last two years. In our unadjusted analyses and our adjusted analyses, food insecurity, lack of internet access, trouble with housing costs, lack of health insurance, and transportation difficulties were associated with statistically significant decreases in mammography screening percentages (p < 0.01) while employment status was not associated with statistically significant differences in mammography screening percentages (p > 0.10). For colorectal cancer screening, 14,765 weighted survey respondents met inclusion criteria of whom 69.0% reported undergoing colorectal cancer screening. In our unadjusted analyses, food insecurity, lack of college education, lack of internet access, trouble with housing costs, lack of health insurance, employment status, and transportation difficulties were associated with statistically significant decreases in colorectal cancer screening percentages (p < 0.001). In our adjusted analyses, internet access (p < 0.001), lack of health insurance (p < 0.001), lack of college education (p < 0.001), and employment status (p < 0.001) were associated with statistically significant decreases in colorectal cancer screening (p < 0.01) while food insecurity (p = 0.224), housing costs (p = 0.628), and transportation delays (p = 0.090) were not associated with colorectal cancer screening percentages. Conclusion: In a nationally representative cross-sectional survey, social determinants of health were associated with decreased breast and colorectal cancer screening percentages. Lack of internet access, health insurance, and formal education were independently associated with decreased cancer screening percentages. Health care systems should develop targeted SDOH interventions to address contextually relevant barriers for breast and colorectal cancer screening. Citation Format: Cameron Fox, Arissa J. Milton, Lewis A. Jordan, Jade A. Anderson, Noelle K. LoConte, Anand K. Narayan. The association between social determinants of health and cancer screening: Cross-sectional survey results from the National Health Interview Survey [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C144.