Neighborhood Factors related to Cancer Screening in Texas: a spatioecological study

INTRODUCTION: To examine the associations of neighborhood socioeconomic status (nSES), ethnic enclaves, residential Black segregation with screening for breast, cervical and colorectal (CRC) cancers across the state of Texas (TX).

METHODS: Using an ecologic study design, spatial clustering of low breast, cervical and CRC screening rates were identified across TX census tracts using local Moran's I statistics. Binomial spatial probit regression was used to estimate the associations between nSES, Hispanic/Latino and Asian American (AA) ethnic enclave neighborhoods and residential Black segregation with geospatial clusters of low screening, adjusting for behavioral characteristics. Analysis was conducted in 2024.

RESULTS: Of 5186 tracts, 5.4%, 4.6%, and 8.7% tracts were in low screening clusters for CRC, cervical and breast cancer, respectively. Medium and high nSES tracts had reduced odds of being part of low cervical cancer screening clusters. Medium nSES tracts and Hispanic enclave tracts had increased odds of being within a low breast cancer screening cluster. AA enclave tracts displayed an increased odds of being in low CRC and low cervical cancer screening clusters. Tracts with high residential Black segregation demonstrated reduced odds of being in low CRC and low breast cancer screening clusters.

CONCLUSIONS: Geospatial clusters of screening uptake are associated with nSES and racial and ethnic neighborhood characteristics. This indicates a need for place-based culturally sensitive interventions to address the specific assets and needs of communities with low screening uptake.