P0474 - Association of English Language Proficiency and Citizenship Status With Colorectal Cancer Screening in the United States

Misha Gautam, MD¹, Utkarsh Goel, MD², Vinay Jahagirdar, MD³, Aron Evans, MD¹, Wendell Clarkston, MD¹, Rajiv Chhabra, MD¹
1University of Missouri - Kansas City School of Medicine, Kansas City, MO; 2Cleveland Clinic Foundation, Cleveland, OH; 3Virginia Commonwealth University Medical Center, Richmond, VA

Introduction: Limited English proficiency (LEP) affects approximately 25 million individuals in the U.S. and can impair colorectal cancer (CRC) screening uptake by limiting comprehension of medical information, healthcare navigation, and provider communication. Immigrant and minority communities, particularly those with LEP, disproportionately experience reduced screening and increased advanced disease presentation. Addressing language barriers specifically is vital since purely structural interventions may not adequately reach LEP populations. In this study, we evaluated the association between LEP, citizenship status, and CRC screening rates.

Methods: We linked CDC’s PLACES database with AHRQ’s SDOH database. We examined how proportions of households with LEP and non-U.S. citizen residents influenced Census tract age-adjusted CRC screening prevalence among adults aged 50–75 across U.S. neighborhoods in 2020, using multiple linear regression (LR).

Results: Of the 72,305 neighborhoods included in PLACES, 49,358 neighborhoods with complete variables of interest comprised our study cohort. Up-to-date CRC screening prevalence varied considerably across neighborhoods (median 70.6%, range 34–88%). Increasing proportions of households with LEP were strongly associated with lower screening rates (Q4 vs. Q1: LR coefficient = -3.6, p< 0.001). Similarly, neighborhoods with higher proportions of non-citizen residents exhibited significantly reduced screening (Q4 vs. Q1: LR coefficient = -2.74, p< 0.001). Areas with the greatest distance to the nearest health clinic experienced a greater detrimental effect on up-to-date CRC screening prevalence due to LEP (61.2% vs. 64.5%). A less dramatic but similar trend was observed among neighborhoods with higher proportions of non-U.S. citizens (65.4% vs. 66.9%).

Discussion: Neighborhoods with a higher proportion of households with LEP had significantly lower rates of CRC screening. LEP had a more profound negative impact on screening uptake than non-citizen status alone. These disparities were most exaggerated in areas with limited access to local healthcare facilities. Language proficiency emerged as a critical, independent barrier—highlighting the need for targeted, language-specific strategies (such as language-concordant care navigation, culturally tailored outreach, and expanding interpreter services) rather than relying solely on citizenship or immigration status as proxies for healthcare vulnerability.


Figure: Association of Limited English Proficiency and Non-Citizen Population with Colorectal Cancer Screening Rates: Multivariable Linear Regression Analysis.
Adjusted for median neighborhood income and total population. Quartile-based estimates are relative to the lowest quartile (Q1).


Figure: Trends in Colorectal Cancer Screening Rates Across Deciles of Households with Limited English Proficiency and Non-Citizen Population, also Stratified by Access to Healthcare
Proportion of age-appropriate up-to-date colorectal cancer screening shown by increasing deciles of households with LEP and non-citizen populations (i.e., decile 10 having the highest proportion of households with LEP and non-citizen population). Lines (black) represent all neighborhoods and those in the fourth quartile of distance to the nearest health clinic.

Disclosures:
Misha Gautam indicated no relevant financial relationships.
Utkarsh Goel indicated no relevant financial relationships.
Vinay Jahagirdar indicated no relevant financial relationships.
Aron Evans indicated no relevant financial relationships.
Wendell Clarkston indicated no relevant financial relationships.
Rajiv Chhabra indicated no relevant financial relationships.

Misha Gautam, MD¹, Utkarsh Goel, MD², Vinay Jahagirdar, MD³, Aron Evans, MD¹, Wendell Clarkston, MD¹, Rajiv Chhabra, MD¹. P0474 - Association of English Language Proficiency and Citizenship Status With Colorectal Cancer Screening in the United States, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.