The coronavirus disease 2019 (COVID-19) pandemic led to a sharp decline in colorectal cancer (CRC) screening.1 These disruptions are expected to have substantial impacts on CRC incidence and mortality rates until 2050.2 Health systems have reacted by encouraging use of noninvasive tests, including fecal immunochemical test (FIT), particularly in areas with limited endoscopic capacity.3 , 4 The impact of these mitigation efforts to augment screening uptake remains unknown. To address this gap, we examined CRC screening before and during the COVID-19 pandemic in a nationally representative sample.
The National Health Interview Survey (NHIS) is an annual survey of US households covering wide ranges of health topics allowing for nationally representative estimates.5 We identified screen-eligible adults (aged 50–75 years, no CRC history) in 2019 and 2021, corresponding to when CRC screening was measured in the NHIS. Response rates were 59.1% in 2019 and 50.9% in 2021. Because of COVID-19, 62.8% of interviews were conducted at least partially by telephone in 2021 compared with 34.3% in 2019. The number of participants meeting inclusion criteria was 13,683 in 2019 and 12,649 in 2021.
We evaluated 2 outcomes: past-year CRC screening, defined as receipt of any screening test within the past 12 months; and up-to-date screening, defined as receipt of colonoscopy within 10 years, flexible sigmoidoscopy or computed tomography colonography within 5 years, FIT-DNA within 3 years, or FIT within 12 months. We examined prior COVID-19 infection, COVID-related delays in medical care, and receipt of COVID-19 vaccination (since April 2021). We used SAS version 9.4 (SAS Institute, Cary, NC) to conduct analyses. We used chi-square tests to compare characteristics between survey years, with weights, strata, and sampling units accounting for the complex survey design.
Proportion of adults up-to-date with screening increased from 66.7% in 2019 to 70.9% in 2021 (P < .01; Table 1 ). Past-year screening increased from 21.2% in 2019 to 24.0% in 2021, with increases in FIT (6.7% to 10.7%) and FIT-DNA (1.7% to 2.3%) but a decrease in colonoscopy (15.2% to 13.5%; all P < .01). The shift toward noninvasive tests persisted across groups defined by age, race and ethnicity, income, and education and was more prominent among adults aged 65–75 years, Black and Hispanic persons, those with a household income <200% of federal poverty level, and persons with less than a high school education.
Table 1.
CRC Screening Before and During COVID-19 Pandemic Among Adults Aged 50–75 Years, National Health Interview Survey 2019–2021
| Up-to-date screening, % (95% CI) |
Past-year CRC screening (CRC screening within 12 mo, % [95% CI]) |
|||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Any tests |
Invasivea |
Noninvasivea |
Colonoscopy |
Sigmoidoscopy |
FIT |
FIT-DNAb |
CT |
|||||||||||
| 2019 | 2021 | 2019 | 2021 | 2019 | 2021 | 2019 | 2021 | 2019 | 2021 | 2019 | 2021 | 2019 | 2021 | 2019 | 2021 | 2019 | 2021 | |
| All participants | 66.7 (65.7–67.7) | 70.9 (69.9–71.9) | 21.2 (20.4–22.0) | 24.0 (23.1–25.0) | 15.5 (14.7–16.2) | 13.8 (13.1–14.5) | 7.0 (6.4–7.5) | 12.8 (12.0–13.6) | 15.2 (14.4–15.9) | 13.5 (12.8–14.2) | 0.9 (0.7–1.1) | 1.1 (0.8–1.3) | 6.7 (6.1–7.2) | 10.1 (9.4–10.8) | 1.7 (1.4–2.0) | 2.3 (2.0–2.6) | 0.6 (0.4–0.7) | 1.1 (0.8–1.3) |
| Age groups | ||||||||||||||||||
| 50–54 years | 45.8 (43.4–48.2) | 51.5 (49.1–53.9) | 18.3 (16.5–20.0) | 22.1 (20.1–24.0) | 15.1 (13.4–16.8) | 13.2 (11.6–14.8) | 4.3 (3.3–5.2) | 10.6 (9.3–12.0) | 15.1 (13.4–16.7) | 12.8 (11.2–14.4) | 0.6 (0.3–0.9) | 0.8 (7.2–9.6) | 4.0 (3.0–4.9) | 8.4 (7.2–9.6) | 1.0 (0.5–1.5) | 1.9 (1.3–2.5) | 0.4 (0.1–0.7) | 0.9 (0.4–1.4) |
| 55–64 years | 67.9 (66.3–69.4) | 71.4 (69.9–73.0) | 19.6 (18.4–20.8) | 22.3 (21.0–23.6) | 14.4 (13.3–15.5) | 13.4 (12.4–14.5) | 6.2 (5.4–7.0) | 11.5 (10.4–12.6) | 14.0 (12.9–15.1) | 13.3 (12.2–14.3) | 0.9 (0.6–1.2) | 1.1 (0.7–1.5) | 6.0 (5.3–6.8) | 9.1 (8.1–10.1) | 1.5 (1.1–1.9) | 1.9 (1.5–2.3) | 0.4 (0.2–0.6) | 1.2 (0.8–1.6) |
| 65–75 years | 78.1 (76.7–79.4) | 81.4 (80.1–82.7) | 25.1 (23.7–26.5) | 27.2 (25.8–28.7) | 17.1 (15.9–18.4) | 14.7 (13.5–15.8) | 9.7 (8.7–10.6) | 15.6 (14.3–16.8) | 16.8 (15.6–18.0) | 14.2 (13.1–15.3) | 1.1 (0.8–1.4) | 1.2 (0.9–1.6) | 9.1 (8.2–10.1) | 12.4 (11.3–13.5) | 2.5 (1.9–3.0) | 3.1 (2.5–3.6) | 0.8 (0.6–1.1) | 1.0 (0.7–1.4) |
| Sex | ||||||||||||||||||
| Men | 64.9 (63.4–66.4) | 69.8 (68.4–71.3) | 20.7 (19.5–21.9) | 23.4 (22.1–24.7) | 15.6 (14.5–16.7) | 14.1 (13.0–15.1) | 6.2 (5.5–7.0) | 12.1 (11.1–13.2) | 15.2 (14.1–16.3) | 13.8 (12.7–14.8) | 0.9 (0.6–1.1) | 1.2 (0.8–1.6) | 6.0 (5.2–6.7) | 9.6 (8.7–10.5) | 1.5 (1.2–1.9) | 2.1 (1.7–2.5) | 0.5 (0.3–0.7) | 1.2 (0.8–1.5) |
| Women | 68.3 (67.0–69.6) | 71.9 (70.6–73.3) | 21.7 (20.6–22.8) | 24.6 (23.4–25.9) | 15.4 (14.4–16.4) | 13.6 (12.6–14.6) | 7.7 (6.9–8.4) | 13.4 (12.4–14.5) | 15.2 (14.2–16.1) | 13.3 (12.3–14.3) | 0.9 (0.7–1.2) | 0.9 (0.7–1.2) | 7.3 (6.5–8.0) | 10.6 (9.7–11.6) | 1.9 (1.4–2.3) | 2.6 (2.1–3.0) | 0.6 (0.4–0.9) | 1.0 (0.7–1.3) |
| Race | ||||||||||||||||||
| White | 70.1 (69.0–71.2) | 74.0 (72.9–75.0) | 20.5 (19.5–21.4) | 23.0 (21.9–24.0) | 15.0 (14.2–15.9) | 13.6 (12.8–14.4) | 6.5 (5.9–7.1) | 11.3 (10.5–12.1) | 14.9 (14.0–15.7) | 13.4 (12.5–14.2) | 0.8 (0.6–0.9) | 0.8 (0.6–1.0) | 6.2 (5.6–6.8) | 8.8 (8.0–9.5) | 1.8 (1.5–2.2) | 2.4 (2.0–2.8) | 0.4 (0.3–0.5) | 0.8 (0.6–1.0) |
| Hispanics | 52.0 (48.6–55.5) | 60.4 (57.0–63.8) | 20.0 (17.5–22.5) | 26.4 (23.6–29.3) | 13.0 (10.9–15.1) | 12.6 (10.6–14.6) | 8.4 (6.6–10.2) | 17.7 (15.0–20.3) | 12.7 (10.6–14.8) | 12.0 (10.0–14.0) | 0.9 (0.4–1.5) | 1.3 (0.6–2.0) | 8.0 (6.2–9.8) | 15.2 (12.8–17.6) | 1.0 (0.4–1.6) | 2.1 (1.2–2.9) | 1.0 (0.3–1.6) | 1.1 (0.6–1.7) |
| Black | 67.0 (64.1–69.9) | 70.2 (67.1–73.2) | 27.4 (24.8–30.0) | 28.2 (25.4–31.0) | 21.9 (19.4–24.5) | 17.1 (14.9–19.4) | 7.4 (5.8–9.1) | 15.2 (12.9–17.5) | 21.1 (18.6–23.7) | 16.7 (14.4–18.9) | 1.7 (1.0–2.4) | 2.1 (1.0–3.2) | 6.7 (5.1–8.2) | 11.7 (9.7–13.8) | 1.9 (0.8–3.0) | 2.4 (1.4–3.3) | 1.5 (0.8–2.2) | 2.2 (1.1–3.4) |
| Asian | 56.0 (50.4–61.7) | 59.6 (54.7–64.6) | 20.8 (17.0–24.7) | 21.4 (17.8–24.9) | 14.2 (10.6–17.8) | 11.1 (8.3–13.9) | 8.4 (5.9–10.8) | 13.2 (10.4–16.0) | 13.5 (10.0–17.0) | 10.8 (8.1–13.4) | 1.4 (0.2–2.5) | 1.2 (0.3–2.1) | 8.4 (5.9–10.8) | 11.2 (8.5–13.9) | 1.1 (0.1–2.1) | 1.6 (0.5–2.6) | 0.1 (0–0.4) | 0.8 (0.1–1.5) |
| Household income | ||||||||||||||||||
| <200% FPL | 55.0 (52.8–57.2) | 60.0 (57.9–62.1) | 20.8 (19.3–22.4) | 25.1 (23.1–27.0) | 14.4 (13.0–15.7) | 13.7 (12.2–15.1) | 8.1 (6.9–9.3) | 15.7 (14.0–17.4) | 14.0 (12.6–15.4) | 13.1 (11.7–14.6) | 1.0 (0.7–1.4) | 2.0 (1.4–2.7) | 7.8 (6.6–8.9) | 12.1 (10.6–13.7) | 2.1 (1.5–2.8) | 2.3 (1.7–2.9) | 0.6 (0.3–1.0) | 2.1 (1.3–2.8) |
| 200%–400% FPL | 65.1 (63.3–67.0) | 69.1 (67.3–71.0) | 20.6 (19.1–22.1) | 23.7 (22.1–25.3) | 14.9 (13.5–16.3) | 13.0 (11.6–14.3) | 7.0 (6.0–7.9) | 12.9 (11.6–14.2) | 14.6 (13.2–16.0) | 12.8 (11.4–14.1) | 1.2 (0.8–1.5) | 0.8 (0.5–1.2) | 6.6 (5.7–7.5) | 10.5 (9.3–11.7) | 1.8 (1.3–2.3) | 2.5 (1.9–3.1) | 0.5 (0.3–0.7) | 0.9 (0.6–1.3) |
| ≥400% FPL | 74.4 (73.1–75.8) | 77.3 (76.1–78.4) | 21.8 (20.6–23.1) | 23.7 (22.5–24.9) | 16.5 (15.4–17.6) | 14.4 (13.4–15.4) | 6.4 (5.6–7.1) | 11.3 (10.4–12.3) | 16.6 (15.1–17.4) | 14.1 (13.1–15.1) | 0.7 (0.5–0.9) | 0.7 (0.5–1.0) | 6.1 (5.3–6.8) | 8.9 (8.1–9.8) | 1.4 (1.0–1.8) | 2.2 (1.9–2.6) | 0.6 (0.3–0.8) | 0.7 (0.5–0.9) |
| Education | ||||||||||||||||||
| <High school | 50.8 (47.2–54.5) | 57.8 (54.3–61.3) | 20.1 (17.5–22.7) | 24.9 (21.6–28.1) | 13.2 (11.1–15.4) | 14.4 (11.9–16.8) | 8.6 (6.7–10.4) | 15.4 (12.6–18.2) | 12.8 10.7–14.9) |
13.8 (11.3–16.2) | 1.1 (0.5–1.6) | 2.5 (1.4–3.5) | 8.2 (6.4–10.0) | 12.9 (10.3–15.5) | 1.9 (1.0–2.8) | 1.6 (0.7–2.5) | 0.7 (0.1–1.3) | 1.7 (0.8–2.6) |
| High school | 63.0 (61.1–64.8) | 66.1 (64.1–68.0) | 20.6 (19.1–22.0) | 23.1 (21.4–24.9) | 15.7 (14.4–17.0) | 13.1 (11.7–14.4) | 6.2 (5.2–7.1) | 12.8 (11.4–14.2) | 15.4 (14.1–16.7) | 12.8 (11.4–14.1) | 0.9 (0.5–1.2) | 1.2 (0.7–1.8) | 5.9 (5.0–6.9) | 9.8 (8.5–11.0) | 1.7 (1.1–2.3) | 2.5 (1.9–3.1) | 0.6 (0.3–0.9) | 1.3 (0.8–1.8) |
| Associate | 69.2 (67.4–70.9) | 72.2 (70.4–74.0) | 21.8 (20.3–23.3) | 24.2 (22.6–25.9) | 15.6 (14.3–17.0) | 13.3 (12.0–14.7) | 7.3 (6.3–8.2) | 13.4 (12.1–14.7) | 15.4 (14.0–16.7) | 13.0 (11.7–14.3) | 1.1 (0.7–1.4) | 0.9 (0.5–1.2) | 6.8 (5.8–7.7) | 10.5 (9.3–11.7) | 1.7 (1.3–2.2) | 2.6 (2.0–3.2) | 0.6 (0.3–0.8) | 1.2 (0.8–1.6) |
| ≥College | 74.7 (73.1–76.3) | 77.3 (75.9–78.7) | 21.9 (20.5–23.3) | 24.4 (22.9–25.8) | 16.3 (15.0–17.5) | 14.6 (13.5–15.7) | 6.8 (5.9–7.6) | 11.6 (10.5–12.7) | 16.0 (14.8–17.2) | 14.4 (13.3–15.5) | 0.7 (0.5–1.0) | 0.7 (0.4–1.0) | 6.6 (5.7–7.4) | 9.4 (8.4–10.4) | 1.5 (1.1–2.0) | 2.1 (1.7–2.6) | 0.4 (0.2–0.6) | 0.6 (0.4–0.9) |
CI, confidence interval; COVID-19, coronavirus disease 2019; CRC, colorectal cancer; CT, computed tomography; FIT, fecal immunochemical test; FPL, federal poverty line.
Invasive studies include colonoscopy and flexible sigmoidoscopy. Noninvasive studies include FIT, FIT-DNA, and CT colonography.
Time since most recent FIT-DNA was not released for survey year 2019.5 For this analysis, respondents were considered to have past-year screening with FIT-DNA if their most recent FIT was part of FIT-DNA and received within 1 year.10 Respondents were considered to have up-to-date screening with FIT-DNA if their most recent FIT was part of FIT-DNA and received within 3 years.10
In 2021, 11.3% reported being diagnosed with COVID-19, and 21.8% reported COVID-19-related delays in medical care (Supplementary Table 1). Past-year screening was similar between participants with and without COVID-19 (25.0% vs 23.8%) and was slightly higher among those reporting delays in care (26.2% vs 23.3%; P < .01). A total of 80.9% participants received at least 1 dose of the COVID-19 vaccine, and past-year screening was higher among this group (25.6% vs 18.6%; P < .01). In multivariable analysis, age 65–75 years (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.09–1.50), Hispanic ethnicity (OR, 1.23; 95% CI, 1.02–1.49), Black race (OR, 1.29; 95% CI, 1.07–1.54), COVID-related delays in care (OR, 1.24; 95% CI, 1.08–1.42), and receiving COVID-19 vaccination (OR, 1.47; 95% CI, 1.26–1.71) were associated with higher past-year screening (Supplementary Table 2).
Despite disruptions caused by the COVID-19 pandemic, CRC screening increased from 2019 to 2021, reaching 70% for the first time since the NHIS began measuring screening. This improvement was associated with an increase in noninvasive testing, occurring among all sociodemographic groups. Studies had reported that the impact of COVID-19 can be mitigated by increasing use of FIT.2, 3, 4 , 6 Our findings reinforce a nationwide effort to increase use of noninvasive tests may be a promising strategy to mitigate COVID-related disruptions in screening, particularly in health systems experiencing insufficient colonoscopy capacity.3 However, this strategy still depends on efforts to optimize diagnostic colonoscopy completion in those with positive FIT.7
We also found that increased use of noninvasive past-year screening tests was more prominent among those with historically lower prevalence of screening, including Hispanic persons and those with a lower income or education, albeit screening up-to-date prevalence still lagged behind White persons and adults with higher income or college education. Widespread disparities in CRC screening before the pandemic are often attributed to multiple barriers to screening, and test preferences.8 Our results suggest that noninvasive or “FIT first” strategies during the pandemic resulted in increased screening among the underserved, and these strategies may also reduce disparities in a postpandemic era.
Past-year CRC screening and up-to-date screening were higher among adults who reported COVID-related delays in care, as health systems attempted to catch-up with missed screening opportunities. Our study is also among the first to show that adults without a COVID-19 vaccine were much less likely to complete CRC screening. Vaccine hesitancy is generally linked not to availability or cost but to safety concerns or medical mistrust,9 whereas being not up-to-date on CRC screening has historically been attributed to economic and structural barriers to care.8 Additional research is needed to develop effective messaging that addresses safety concerns and medical mistrust, for both CRC screening and vaccination.
A strength of our study includes the nationally representative sample with detailed information on CRC screening before and during the COVID-19 pandemic. We were also able to examine how CRC screening was related to COVID-19 experiences, including medical care delays or vaccination.2, 3, 4 Notably, NHIS did not measure CRC screening in its 2020 survey at the height of pandemic. We did not include adults aged 45–49 years because the US Preventive Services Task Force did not yet recommend average-risk screening in 2019 for this group. In 2019 the NHIS inadvertently did not inquire about the most recent FIT-DNA date for about 20% of adults who ever had a FIT-DNA.5 , 10 The NHIS was also redesigned in 2019, and therefore results cannot be directly compared with survey years 2000–2018. Other limitations include lack of information to identify adults at high-risk of CRC and self-reported screening.
In summary, we found that nationwide CRC screening increased to above 70% in 2021, accompanied by an increase in the use of noninvasive tests, particularly among historically underscreened populations. Moving forward, noninvasive tests may help continue to mitigate the impact of COVID-19 on CRC screening and provide a strategy to reduce disparities.
Footnotes
Conflicts of interest These authors disclose the following: Amit G. Singal reports consulting for Exact Sciences. Caitlin C. Murphy reports consulting for Freenome. The remaining author discloses no conflicts.
Funding This work was supported by the National Institutes of Health (R01 CA242558, T32 DK007745, KL2 TR001103), and Cancer Prevention Research Institute of Texas (PP160075).
Note: To access the supplementary material accompanying this article, visit the online version of Clinical Gastroenterology and Hepatology at www.cghjournal.org, and at https://doi.org/10.1016/j.cgh.2022.12.014.
Appendix
Supplementary Table 1.
CRC Screening During COVID-19 Pandemic Among Adults Aged 50–75 Years, National Health Interview Survey 2021
| Up-to-date screening, % (95% CI) | Past-year CRC screening (CRC screening within 12 mo, % [95% CI]) |
|||||
|---|---|---|---|---|---|---|
| Any tests | Invasivea | Noninvasivea | Colonoscopy | FIT | ||
| Had COVID-19 infection | ||||||
| Yes (11.3%) | 69.3 (66.1–72.5) | 25.0 (22.2–27.9) | 16.0 (13.6–18.4) | 12.1 (9.8–14.3) | 15.6 (13.2–18.0) | 9.4 (7.3–11.5) |
| No (88.7%) | 71.3 (70.3–72.3) | 23.8 (22.8–24.8) | 13.5 (12.7–14.2) | 12.7 (11.9–13.6) | 13.2 (12.4–13.9) | 10.1 (9.4–10.9) |
| Had delayed care because of COVID-19 | ||||||
| Yes (21.8%) | 75.4 (73.5–77.4) | 26.2 (24.2–28.1) | 14.6 (13.1–16.1) | 14.4 (12.8–16.0) | 14.4 (12.9–15.9) | 11.8 (10.3–13.3) |
| No (78.2%) | 69.9 (68.7–71.0) | 23.3 (22.2–24.3) | 13.5 (12.7–14.4) | 12.2 (11.3–13.0) | 13.2 (12.4–14.0) | 9.5 (8.8–10.3) |
| Received COVID-19 vaccinationb | ||||||
| Yes (80.9%) | 75.1 (73.9–76.3) | 25.6 (24.3–26.8) | 14.7 (13.8–15.6) | 13.6 (12.6–14.6) | 14.4 (13.5–15.3) | 10.7 (9.8–11.6) |
| No (19.1%) | 53.7 (50.9–56.4) | 18.6 (16.4–20.7) | 10.0 (8.3–11.7) | 10.4 (8.7–12.0) | 9.6 (8.0–11.2) | 8.2 (6.8–9.7) |
CI, confidence interval; COVID-19, coronavirus disease 2019; CRC, colorectal cancer; CT, computed tomography; FIT, fecal immunochemical test.
Invasive studies include colonoscopy and flexible sigmoidoscopy. Noninvasive studies include FIT, FIT-DNA, and CT colonography.
Limit to second to fourth quarter of 2021 when COVID-19 vaccination information is available in National Health Interview Survey.
Supplementary Table 2.
Prevalence and Factors Associated With Past-Year CRC Screening During COVID-19 Pandemic Among Adults Aged 50–75 Years, National Health Interview Survey 2021
| Prevalence of past-year screening, % (95% CI) | Univariable OR (95% CI) | Multivariable OR (95% CI) | |
|---|---|---|---|
| Age groups | |||
| 50–54 y | 22.3 (20.0–24.6) | 1 (Reference) | 1 (Reference) |
| 55–64 y | 22.6 (21.0–24.3) | 1.02 (0.87–1.19) | 1.01 (0.86–1.18) |
| 65–75 y | 27.2 (25.5–28.8) | 1.30 (1.11–1.52) | 1.28 (1.09–1.50) |
| Sex | |||
| Male | 23.1 (21.6–24.6) | 1 (Reference) | 1 (Reference) |
| Female | 25.3 (23.8–26.7) | 1.12 (1.01–1.25) | 1.10 (0.98–1.22) |
| Race | |||
| White | 23.3 (22.1–24.6) | 1 (Reference) | 1 (Reference) |
| Hispanics | 27.0 (23.6–30.3) | 1.21 (1.01–1.46) | 1.23 (1.02–1.49) |
| Black | 27.8 (24.4–31.2) | 1.27 (1.06–1.52) | 1.29 (1.07–1.54) |
| Asian | 22.2 (18.0–26.3) | 0.94 (0.73–1.20) | 0.92 (0.71–1.18) |
| Household income | |||
| <200% FPL | 25.4 (23.1–27.8) | 1 (Reference) | 1 (Reference) |
| 200%–400% FPL | 24.0 (22.0–26.0) | 0.93 (0.79–1.09) | 0.92 (0.78–1.08) |
| ≥400% FPL | 23.8 (22.4–25.2) | 0.92 (0.80–1.06) | 0.90 (0.77–1.05) |
| Education | |||
| <High school | 24.7 (20.9–28.6) | 1 (Reference) | 1 (Reference) |
| High school | 23.7 (21.7–25.7) | 0.95 (0.75–1.19) | 1.02 (0.81–1.30) |
| Associate | 23.7 (21.8–25.6) | 0.95 (0.75–1.19) | 1.03 (0.81–1.30) |
| ≥College | 24.9 (23.2–26.6) | 1.01 (0.81–1.26) | 1.09 (0.86–1.38) |
| Had COVID–19 infection | |||
| No | 24.0 (22.9–25.2) | 1 (Reference) | 1 (Reference) |
| Yes | 25.7 (22.5–28.9) | 1.09 (0.91–1.31) | 1.15 (0.96–1.38) |
| Had delayed care because of COVID–19 | |||
| No | 23.3 (22.1–24.5) | 1 (Reference) | 1 (Reference) |
| Yes | 27.8 (25.5–30.1) | 1.27 (1.11–1.45) | 1.24 (1.08–1.42) |
| Received COVID–19 vaccination | |||
| No | 18.6 (16.4–20.7) | 1 (Reference) | 1 (Reference) |
| Yes | 25.7 (24.3–26.8) | 1.51 (1.30–1.75) | 1.47 (1.26–1.71) |
NOTE. Analysis limit to second to fourth quarter of 2021 when COVID-19 vaccination information is available in National Health Interview Survey. CI, confidence interval; COVID-19, coronavirus disease 2019; CRC, colorectal cancer; FPL, federal poverty line; OR, odds ratio.
References
- 1.Chen R.C., et al. JAMA Oncol. 2021;7:878–884. doi: 10.1001/jamaoncol.2021.0884. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.de Jonge L., et al. Lancet Gastroenterol Hepatol. 2021;6:304–314. doi: 10.1016/S2468-1253(21)00003-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Myint A., et al. Gastroenterology. 2021;161:712–714. doi: 10.1053/j.gastro.2021.04.026. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Marcondes F.O., et al. Prev Med. 2021;151 doi: 10.1016/j.ypmed.2021.106640. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.National Center for Health Statistics . Survey Description, National Health Interview Survey, 2019. Hyattsville, Maryland; 2020. [Google Scholar]
- 6.Issaka R.B., et al. JAMA Netw Open. 2021;4 doi: 10.1001/jamanetworkopen.2021.22661. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Martin J., et al. Am J Med. 2017;130:93. doi: 10.1016/j.amjmed.2016.07.028. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Carethers J.M., et al. Gastroenterology. 2020;158:354–367. doi: 10.1053/j.gastro.2019.10.029. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Altmann D.M., et al. Science. 2022;375:1127–1132. doi: 10.1126/science.abn1755. [DOI] [PubMed] [Google Scholar]
- 10.Sabatino S.A., et al. Am J Prev Med. 2022;63:431–439. doi: 10.1016/j.amepre.2022.02.018. [DOI] [PMC free article] [PubMed] [Google Scholar]