S530 Colorectal Cancer Screening and Mortality Trends in the U.S. (1999–2024): A Story of Success and Inequity

Introduction: Colorectal cancer (CRC) is a critical tool for early detection and prevention of colorectal cancer (CRC). Despite advancements in screening technologies, disparities in access and uptake persist across racial, socioeconomic, and demographic groups. This study analyzes trends in CRC screening rates and their correlation with mortality, using data from Behavioral Risk Factor Surveillance System (BRFSS) and CDC WONDER spanning from 1999 to 2024. Methods: CRC screening rates were extracted from the BRFSS for individuals aged 45 and older, spanning 1999 to 2023. CRC Age-adjusted mortality rates (AAMRs) were obtained from CDC WONDER database up to 2024. Temporal Trends in screening rates and AAMRs were analyzed using Join point Regression to calculate annual percent changes (APC). Correlation analysis was performed to explore associations between screening rates and AAMRs. Results: Age-adjusted CRC screening rates increased from 41.53% in 1999 to 76.30% in 2023. Whites had the - highest rates (80.09%) followed by African Americans (AA) with a screening rate of (70.14%), while Hispanics had a screening rate of (64.86%) in 2023. Significant socioeconomic disparities in screening rates were observed between insured (who had a screening rate of 78.13) and uninsured individuals, who recorded a screening rate of 33.02%, and experienced a sharp decline from 2018 to 2022 (APC: -9.94). CRC AAMR declined significantly in individuals >45 over time from 69.3 in 1999 to 40.7 in 2024. AAs recorded the highest AAMR of 48.8 followed by Whites, who recorded an AAMR of 40.9 in 2024, while Asians recorded the lowest AAMR of 26.7 (25.6–27.8) in 2024. There was a strong negative correlation (-0.885) between screening and CRC mortality. Correlation analysis revealed stronger associations for Whites and AAs (-0.9761) compared to lower associations in Hispanics (-0.459). The projected CRC-AAMR at a 100% screening rate was 18.92, compared to 40.4 at a screening rate of 76.3%. AAs had the highest projected AAMR (21.39 deaths per 100,000), suggesting additional factors contributing to CRC mortality in this group more than other races. A noticeable decline in CRC screening rates in 2020, followed by a gradual increase in subsequent years due to the COVID-19 pandemic. Conclusion: While CRC screening rates have improved overall, significant racial, and insurance-based disparities remain. Targeted, equity-focused interventions are essential to close these gaps and achieve uniform mortality gains.