Perceived Economic Strain, Subjective Social Status, and Colorectal Cancer Screening Utilization in U.S. Men—A Cross-Sectional Analysis

Abstract

Although socioeconomic status (SES) is fundamentally related to underutilization of colorectal cancer (CRC) screening, the role of perceived economic strain and subjective social status with CRC screening is understudied. The aim of this study was to investigate whether greater perceived economic strain or lower subjective social status would decrease the odds of CRC screening uptake and being up-to-date with guideline-recommended CRC screening. We also explored interactions with household income and educational attainment. Cross-sectional survey-based data from men aged 45–75 years living in the United States (N = 499) were collected in February 2022. Study outcomes were ever completing a stool- or exam-based CRC screening test and being up-to-date with CRC screening. Perceived economic strain and subjective social status were the predictors. We conducted logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI). Greater perceptions of economic strain decreased odds of being up-to-date with CRC screening. Household income modified the association between perceived economic strain and completing a stool-based test; the association was stronger for men from lower-income households. In unadjusted models, higher subjective social status increased odds of completing an exam-based test and being up-to-date with CRC screening. Our findings suggest that experiencing economic strain may interfere with men’s CRC screening decisions and may capture additional information about barriers to CRC screening utilization beyond those captured by income or education.

Keywords:

• cancer early detection
• colorectal neoplasms
• secondary prevention
• social class
• socioeconomic factors

Acknowledgements

The research team extends gratitude to the participants who made the study possible as well as to Eleanor Mayfield, ELS, for editorial assistance. The data reported in this study are available from the corresponding author upon reasonable request.

Disclosure statement

Dr. Charles R. Rogers offers scientific input to research studies through an agreement with Exact Sciences. For the remaining authors, no conflicts of interests were declared.

Data availability statement

De-identified data and the analytic code used to conduct the analyses presented in this study are available on Open Science Framework: https://osf.io/26x83/.

Additional information

Funding

This project was partly supported by the Health Studies Fund, Department of Family and Preventive Medicine, University of Utah; 5 For the Fight; Huntsman Cancer Institute; the V Foundation for Cancer Research; the Medical College of Wisconsin; and the National Cancer Institute [Grant K01CA234319], an entity of the National Institutes of Health (NIH). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, 5 For the Fight, V Foundation for Cancer Research, Huntsman Cancer Institute, the Huntsman Cancer Foundation, the Medical College of Wisconsin, or the University of Utah.