Colorectal Cancer Screening and Health-Related Social Needs in a National Sample of US Adults

Importance: Health-related social needs (HRSNs) may impede colorectal cancer (CRC) screening among US adults, yet population-based evidence on these associations remains limited. Objective: To examine associations between HRSNs and CRC screening uptake overall and by age group among US adults. Design, Setting, and Participants: This cross-sectional study used data from the 2023 National Health Interview Survey. Participants were US civilian, noninstitutionalized adults aged 45 to 75 years eligible for CRC screening. Age-stratified analyses were conducted for adults aged 45 to 49 years, 50 to 64 years, and 65 to 75 years. Data analysis was performed from April 2025 to February 2026. Exposures: Self-reported HRSNs, including housing instability, food insecurity, transportation barriers, and number of unmet needs. Main Outcomes and Measures: The primary outcome was being up to date with CRC screening according to US Preventive Services Task Force recommendations. Survey-weighted logistic regression models estimated adjusted odds ratios (aORs) and 95% CIs overall and by age group. Results: The analytic sample included 14 528 adults aged 45 to 75 years, and most participants were aged 50 to 64 years (6940 individuals [52.42%]), female (7788 individuals [51.36%]), insured (13 750 participants [94.07%]), and reported no unmet HRSNs (12 370 participants [85.40%]). Overall, 2158 adults (14.60%) reported at least 1 unmet HRSN. The proportion up to date with CRC screening was 63.91% (9758 adults) overall and increased with age, from 31.01% (586 adults) among adults aged 45 to 49 years to 64.24% (4539 adults) among those aged 50 to 64 years, and 80.85% (4633 adults) among those aged 65 to 75 years. In adjusted models, housing instability (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. Screening odds declined with increasing number of unmet HRSNs, including among adults reporting 1 unmet need (aOR, 0.84; 95% CI, 0.72-0.98). Associations were most pronounced among adults aged 50 to 64 years, among whom 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 associated with lower odds of being up to date with screening. Conclusions and Relevance: In this cross-sectional study, unmet HRSNs were associated with lower CRC screening uptake, particularly among adults aged 50 to 64 years. Addressing HRSNs may support age-specific strategies to improve CRC screening.