Prevalence of Non-Screening for Colorectal Cancer: Comparing a Rural State to the United States

Background: The incidence and mortality of Colorectal Cancer (CRC) in North Dakota (ND) areamong the highest in the United States (US). In addition, screening rates for CRC in ND have remained consistently lower than that of the nation in recent years. This study aims to (1) determine the predictors of non-screening of CRC;(2) compare the prevalence of self-reported CRC screening among ND and US populations; and (3) identify the high-risk geographical areas for possible future CRC prevention initiatives. Methods: We used data of 232,429 adults (aged 50-75 years) who had an annual physical examination from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) to describe individuals who never received CRC screening. Results: CRC non-screening rateswere significantly higher among North Dakotans than the rest of the US population (32% vs. 27%; p<0.0001). ND individuals who were 50 to 64 years old (38% vs. 32%; p < 0.0001), individuals living in rural ND (39% vs. 25%; p < 0.0001) and lack of insurance (ND: 62% vs. US: 57%) were less likely to report CRC screening than the U.S. population. Adjusting for multiple variables, ND individuals were significantly less likely to report CRC screening (aOR=0.74; 95% CI [0.66-0.83]) than the U.S. respondents. Conclusions: The prevalence of individuals who never received CRC screening in ND is higher than in the U.S. Interventions tailored towards individuals with a lower education, living in a rural area, and lacking a personal doctor and health insurance could enhance CRC screening.