S522 Association of English Language Proficiency and Citizenship Status With Colorectal Cancer Screening in the United States

Introduction: Limited English proficiency (LEP) affects approximately 25 million individuals in the U.S. and can impair colorectal cancer (CRC) screening uptake by limiting comprehension of medical information, healthcare navigation, and provider communication. Immigrant and minority communities, particularly those with LEP, disproportionately experience reduced screening and increased advanced disease presentation. Addressing language barriers specifically is vital since purely structural interventions may not adequately reach LEP populations. In this study, we evaluated the association between LEP, citizenship status, and CRC screening rates. Methods: We linked CDC’s PLACES database with AHRQ’s SDOH database. We examined how proportions of households with LEP and non-U.S. citizen residents influenced Census tract age-adjusted CRC screening prevalence among adults aged 50–75 across U.S. neighborhoods in 2020, using multiple linear regression (LR). Results: Of the 72,305 neighborhoods included in PLACES, 49,358 neighborhoods with complete variables of interest comprised our study cohort. Up-to-date CRC screening prevalence varied considerably across neighborhoods (median 70.6%, range 34%–88%). Increasing proportions of households with LEP were strongly associated with lower screening rates (Q4 vs Q1: LR coefficient = -3.6, P < 0.001). Similarly, neighborhoods with higher proportions of non-citizen residents exhibited significantly reduced screening (Q4 vs Q1: LR coefficient = -2.74, P < 0.001). Areas with the greatest distance to the nearest health clinic experienced a greater detrimental effect on up-to-date CRC screening prevalence due to LEP (61.2% vs 64.5%). A less dramatic but similar trend was observed among neighborhoods with higher proportions of non-U.S. citizens (65.4% vs 66.9%). Conclusion: Neighborhoods with a higher proportion of households with LEP had significantly lower rates of CRC screening. LEP had a more profound negative impact on screening uptake than non-citizen status alone. These disparities were most exaggerated in areas with limited access to local healthcare facilities. Language proficiency emerged as a critical, independent barrier—highlighting the need for targeted, language-specific strategies (such as language-concordant care navigation, culturally tailored outreach, and expanding interpreter services) rather than relying solely on citizenship or immigration status as proxies for healthcare vulnerability.