Unmet Health-Related Social Needs Tied to Lower CRC Screening, Especially Among Adults Aged 50 to 64

Adults with unmet health-related social needs (HRSNs) are significantly less likely to be up to date on colorectal cancer (CRC) screening, with the widest gap among those between ages 50 and 64, according to a study published in JAMA Network Open.¹

CRC Screening Gaps and HRSNs

Despite being largely preventable through routine screening, CRC is the second leading cause of cancer-related deaths in the US. The US Preventive Services Task Force (USPSTF) recommends regular screening for adults aged 45 to 75 at average risk using stool-based or direct visualization tests.² However, national screening rates remain suboptimal, particularly among younger adults, individuals facing socioeconomic disadvantages, and minoritized racial and ethnic populations.¹

As a result, HRSNs, defined as adverse social conditions that affect health outcomes, have emerged as important factors influencing CRC screening behavior. Prior research has linked individual HRSNs, like financial strain or transportation challenges, to lower screening rates, but less is known about how co-occurring HRSNs interact to influence screening behavior.

In line with the USPSTF recommendations, investigators evaluated age-stratified associations between HRSNs and CRC screening among US adults aged 45 to 75. They hypothesized that individuals reporting HRSNs would be less likely to have completed CRC screening and that associations would differ by age.

The cross-sectional study used data from the 2023 National Health Interview Survey (NHIS), a nationally representative survey of the civilian, noninstitutionalized US population. The primary outcome was self-reported CRC screening, defined according to USPSTF guidelines. In addition, the researchers assessed HRSNs using NHIS items on food insecurity, housing instability, and transportation barriers.

Data analysis was performed from April 2025 to February 2026. The researchers conducted age-stratified analyses for adults aged 45 to 49, 50 to 64, and 65 to 75.

Key Findings

The analytic sample included 14,528 adults, most of whom were female (51.36%; n = 7788) and aged 50 to 64 (52.42%; n = 6940). Regarding race and ethnicity, 1741 (14.51%) individuals were Hispanic, 1648 (11.06%) were non-Hispanic Black, 10,198 (66.72%) were non-Hispanic White, and 941 (7.71%) were non-Hispanic other races.

Overall, 63.91% (n = 9758) were up to date with CRC screening. The researchers highlighted that the CRC screening rate increased with age, from 31.01% (n = 586) among adults aged 45 to 49 to 64.24% (n = 4539) among those aged 50 to 64 and 80.85% (n = 4633) among adults aged 65 to 75.

Of the study population, approximately 14.6% (n = 2158) reported at least 1 unmet HRSN, including food insecurity (8.21%; n = 1171), housing instability (6.54%; n = 902), and transportation barriers (6.00%; n = 915). In adjusted models, housing instability (adjusted OR [aOR], 0.82; 95% CI, 0.67-0.99) and transportation barriers (aOR, 0.78; 95% CI, 0.64-0.95) were associated with lower odds of being up to date with CRC screening.

The researchers also found that screening odds declined as the number of unmet HRSNs increased, even among adults reporting just 1 unmet need (aOR, 0.84; 95% CI, 0.72-0.98). The associations were most pronounced among those aged 50 to 64. In this group, housing instability (aOR, 0.77; 95% CI, 0.61-0.97), transportation barriers (aOR, 0.71; 95% CI, 0.56-0.91), and reporting 1 HRSN (aOR, 0.80; 95% CI, 0.66-0.97) were all linked to lower odds of being up to date with CRC screening, while food insecurity was not.

Limitations and Implications for CRC Screening Equity

The researchers acknowledged several limitations, including that all variables were based on self-reports and may be subject to recall or social desirability bias. Additionally, causal inferences cannot be made due to the cross-sectional design. However, they expressed confidence in their findings and concluded by suggesting ways to increase CRC screening rates.

“Our findings underscore the importance of addressing cumulative social risk within both clinical and community-based prevention efforts,” the investigators wrote. “Interventions that integrate social care into health care workflows and address multiple barriers simultaneously may help reduce persistent disparities in CRC screening and outcomes.”

References

1. Ewing AP, Tounkara F, Lawrence WR, et al. Colorectal cancer screening and health-related social needs in a national sample of US adults. JAMA Netw Open. 2026;9(4):e266000. doi:10.1001/jamanetworkopen.2026.6000
2. Colorectal cancer: screening. USPSTF. May 18, 2021. Accessed April 11, 2026. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening#tab