1 Study overview

This cross-sectional study examines colorectal cancer screening among Arkansas adults aged 45–75 using the 2022 and 2024 Behavioral Risk Factor Surveillance System (BRFSS) public-use datasets. The primary outcome is being up to date with screening according to the CDC calculated colorectal screening variable.

Estimates account for BRFSS sampling weights, strata, and primary sampling units. Survey-weighted logistic regression assesses associations with age, sex, race and ethnicity, education, income, insurance, access to a personal healthcare provider, metropolitan residence, smoking, and survey year.

We also evaluate age-group interactions and perform sensitivity analyses using alternative age ranges and inverse-probability weighting for observed screening outcomes. Associations are observational and should not be interpreted as causal effects.

2 Data sources and study sample

The study uses the CDC 2022 and 2024 BRFSS annual public-use SAS transport files. The import step retains Arkansas records (state code 5) and caches the selected variables locally for subsequent runs.

## Arkansas_2022 Arkansas_2024 
##          5309          5344

Respondent counts refer to the Arkansas annual BRFSS records before age and outcome restrictions.

2.1 Harmonization across survey years

Some variable names change suffix between years (for example _CRCREC2 in 2022 and _CRCREC3 in 2024), so each is picked up by its prefix.

2.2 Variable definitions and recoding

The original CDC variables are retained in the analysis dataset alongside recoded fields. The categories below correspond to the model inputs.

Analysis variable Source variable Operational definition
Up to date with screening _CRCREC2 (2022), _CRCREC3 (2024) Yes = 1; overdue or never screened = 0; unavailable response = missing
Age group _AGE80 45–54, 55–64, 65–75 years; 65–75 is the model reference
Sex _SEX Female (reference), male
Race/ethnicity _IMPRACE White (reference), Black, Hispanic, other
Education _EDUCAG College graduate (reference), some college, high school, less than high school
Household income _INCOMG $50,000 or more (reference), $25,000–49,999, under $25,000, not reported
Insurance _HLTHPL Insured (reference), uninsured
Personal healthcare provider PERSDOC variables Has provider (reference), no provider
Metropolitan residence _METSTAT Metropolitan (reference), nonmetropolitan
Smoking _SMOKER Never (reference), former, current
Survey year Interview year 2022 (reference), 2024

Unknown, refused, or inapplicable responses remain missing unless a separate not reported group is explicitly specified. Missing screening outcomes are not treated as unscreened. The underlying source fields are not overwritten.

2.3 Survey design

## Original Arkansas records by year:
## 
## 2022 2024 
## 5309 5344
## Screening-valid records by year:
## Year
## 2022 2024 
## 2654 2688
## Missing screening outcome among age 45–75 by year:
##       
## year   FALSE TRUE
##   2022  2654  454
##   2024  2688  250

3 Survey-weight and prevalence quality checks

The verification compares weighted prevalence with reference estimates calculated directly from the source-year data using _LLCPWT. A tolerance of 0.15 percentage points is used to identify unexpected changes in data processing or weight selection.

Year Weighted screening (%) Reference estimate (%)
2022 2022 64.0 64.0
2024 2024 68.1 68.1

4 Screening prevalence by population group

Up to date with colorectal cancer screening, Arkansas adults aged 45-75
Characteristic Group n Percent Lower Upper
yearf 2022 2654 64.0 61.8 66.3
yearf 2024 2688 68.1 65.9 70.2
agegrp 65-75 2305 79.7 77.7 81.7
agegrp 45-54 1313 45.4 42.3 48.6
agegrp 55-64 1724 72.3 69.8 74.8
sex Female 2943 68.4 66.3 70.5
sex Male 2399 63.8 61.4 66.1
race White 4312 68.1 66.4 69.7
race Black 662 66.1 61.5 70.7
race Hispanic 118 37.4 27.4 47.4
race Other 250 60.6 52.8 68.4
educ College graduate 1810 71.3 68.8 73.8
educ Some college 1481 69.4 66.6 72.2
educ High school 1669 62.7 59.9 65.4
educ Less than high school 371 57.2 51.3 63.0
income3 $50,000 or more 2216 68.4 66.0 70.7
income3 $25,000-49,999 1242 67.0 63.7 70.3
income3 Under $25,000 1068 62.2 58.6 65.8
income3 Not reported 816 63.8 59.7 67.9
insured Insured 4911 68.4 66.8 70.0
insured Uninsured 192 29.4 21.7 37.2
provider Has provider 4992 69.2 67.7 70.8
provider No provider 312 27.8 22.0 33.6
metro Metropolitan 2843 68.1 66.0 70.2
metro Nonmetropolitan 2499 63.5 61.1 65.8
smoke Never 2730 67.3 65.2 69.5
smoke Former 1567 69.5 66.6 72.4
smoke Current 974 57.9 54.2 61.7

5 Screening modality indicators by income

Test Income Percent Lower Upper
Colonoscopy within 10 years $50,000 or more 64.2 61.9 66.6
Colonoscopy within 10 years $25,000-49,999 62.5 59.1 66.0
Colonoscopy within 10 years Under $25,000 54.7 51.1 58.4
Colonoscopy within 10 years Not reported 58.8 54.6 63.0
Stool blood test within 1 year $50,000 or more 6.8 5.6 8.0
Stool blood test within 1 year $25,000-49,999 7.1 5.5 8.8
Stool blood test within 1 year Under $25,000 9.9 7.6 12.1
Stool blood test within 1 year Not reported 6.0 4.2 7.7
Stool DNA test within 3 years $50,000 or more 3.2 2.4 4.1
Stool DNA test within 3 years $25,000-49,999 4.7 2.8 6.6
Stool DNA test within 3 years Under $25,000 5.6 3.8 7.3
Stool DNA test within 3 years Not reported 3.6 2.1 5.1

6 Multivariable logistic regression

Odds ratios below 1 mean lower odds of being up to date than the reference group. Reference groups: age 65-75, female, White, 2022, college graduate, income of $50,000 or more, insured, has a provider, metropolitan, never smoked.

Model 1: demographics
Term OR Lower Upper p
agegrp45-54 0.218 0.183 0.261 0.000
agegrp55-64 0.678 0.568 0.810 0.000
sexMale 0.805 0.695 0.933 0.004
raceBlack 0.994 0.794 1.244 0.960
raceHispanic 0.368 0.238 0.570 0.000
raceOther 0.878 0.616 1.251 0.471
yearf2024 1.263 1.091 1.462 0.002
Model 2: + education and income
Term OR Lower Upper p
agegrp45-54 0.203 0.168 0.244 0.000
agegrp55-64 0.665 0.556 0.795 0.000
sexMale 0.816 0.702 0.948 0.008
raceBlack 1.058 0.846 1.323 0.623
raceHispanic 0.409 0.262 0.637 0.000
raceOther 0.901 0.629 1.291 0.570
yearf2024 1.226 1.058 1.422 0.007
educSome college 0.890 0.734 1.080 0.237
educHigh school 0.653 0.540 0.790 0.000
educLess than high school 0.589 0.434 0.799 0.001
income3$25,000-49,999 0.858 0.698 1.055 0.146
income3Under $25,000 0.791 0.635 0.984 0.036
income3Not reported 0.723 0.573 0.913 0.006
Model 3 (main): + insurance, provider, residence, smoking
Term OR Lower Upper p
agegrp45-54 0.233 0.191 0.284 0.000
agegrp55-64 0.753 0.624 0.909 0.003
sexMale 0.854 0.729 1.002 0.052
raceBlack 1.070 0.837 1.368 0.589
raceHispanic 0.526 0.317 0.875 0.013
raceOther 0.885 0.600 1.307 0.540
yearf2024 1.228 1.051 1.436 0.010
educSome college 0.960 0.784 1.176 0.696
educHigh school 0.746 0.609 0.915 0.005
educLess than high school 0.682 0.488 0.953 0.025
income3$25,000-49,999 0.976 0.785 1.213 0.826
income3Under $25,000 0.890 0.703 1.127 0.334
income3Not reported 0.781 0.605 1.007 0.057
insuredUninsured 0.440 0.272 0.712 0.001
providerNo provider 0.279 0.197 0.396 0.000
metroNonmetropolitan 0.724 0.618 0.848 0.000
smokeFormer 1.093 0.909 1.314 0.347
smokeCurrent 0.844 0.680 1.047 0.124

7 Effect modification analyses

Each interaction is added to the main model and tested with a Wald test.

Interaction F df p
Age group x income 1.136 6 0.339
Age group x sex 1.921 2 0.147
Age group x survey year 0.180 2 0.835

7.1 Income within each age group

Adjusted odds ratios for income, by age group
Age group Term OR Lower Upper p
45-54 income3$25,000-49,999 0.837 0.562 1.246 0.381
45-54 income3Under $25,000 0.856 0.585 1.253 0.424
45-54 income3Not reported 0.984 0.604 1.601 0.947
55-64 income3$25,000-49,999 0.937 0.656 1.338 0.722
55-64 income3Under $25,000 0.881 0.607 1.278 0.503
55-64 income3Not reported 0.714 0.476 1.070 0.102
65-75 income3$25,000-49,999 0.717 0.497 1.035 0.076
65-75 income3Under $25,000 0.523 0.343 0.797 0.003
65-75 income3Not reported 0.531 0.361 0.782 0.001

7.2 Change from 2022 to 2024 within each age group

Age group Year Percent Lower Upper
65-75 2022 78.7 75.8 81.6
45-54 2022 41.9 37.4 46.3
55-64 2022 69.3 65.5 73.1
65-75 2024 80.6 77.8 83.4
45-54 2024 48.4 44.0 52.9
55-64 2024 75.2 72.0 78.5

8 Secondary analysis: never screened

Adjusted odds ratios for never having been screened
Term OR Lower Upper p
agegrp45-54 6.392 5.123 7.975 0.000
agegrp55-64 1.536 1.228 1.921 0.000
sexMale 1.264 1.060 1.508 0.009
raceBlack 1.056 0.807 1.381 0.691
raceHispanic 2.065 1.224 3.482 0.007
raceOther 0.997 0.650 1.528 0.989
yearf2024 0.744 0.625 0.886 0.001
educSome college 1.037 0.826 1.301 0.755
educHigh school 1.357 1.083 1.701 0.008
educLess than high school 1.508 1.046 2.175 0.028
income3$25,000-49,999 1.013 0.795 1.292 0.914
income3Under $25,000 1.173 0.906 1.518 0.226
income3Not reported 1.222 0.918 1.625 0.169
insuredUninsured 2.231 1.355 3.673 0.002
providerNo provider 3.417 2.390 4.884 0.000
metroNonmetropolitan 1.280 1.073 1.527 0.006
smokeFormer 0.898 0.733 1.102 0.303
smokeCurrent 1.125 0.884 1.433 0.339

9 Screening by age and household income

10 Analysis sample sizes

## Valid screening outcomes: 5342
## Full adjusted regression sample: 4999

11 Sensitivity analyses

CDC’s calculated colorectal screening indicators differ by survey year: _CRCREC2 in 2022 and _CRCREC3 in 2024. The source documentation also specifies differences in the underlying age information used to construct these indicators. We therefore examine the screening trend in narrower age ranges. These analyses assess robustness; they do not make the CDC indicators fully equivalent across years.

11.1 Screening by year in narrower age ranges

If the estimated time trend is comparable when excluding participants near the lower/upper boundaries, this supports robustness to the chosen age range, but does not prove that the outcome algorithms are identical.

Age-range sensitivity, with correct final BRFSS survey weights
Age_range Year Rate_pct CI_low CI_high
45-75 (primary) 2022 64.03 61.75 66.30
45-75 (primary) 2024 68.08 65.93 70.24
50-75 2022 69.20 66.87 71.54
50-75 2024 74.05 71.93 76.18
50-74 2022 68.78 66.39 71.17
50-74 2024 74.02 71.86 76.19
55-74 2022 73.51 71.00 76.03
55-74 2024 77.99 75.81 80.18 
## 
## Percentage-point changes (2024 minus 2022):
## 45-75 (primary): 4.05
## 50-75: 4.85
## 50-74: 5.24
## 55-74: 4.48

11.2 Missing-outcome patterns

The counts below are unweighted sample characteristics, not estimated population prevalences. Missing screening outcomes can reflect nonresponse, question skip patterns or incomplete information for the CDC-derived outcome; we do not assume missing means unscreened.

## 
## Outcome availability by year (unweighted):
##       Observed
## Year      0    1
##   2022  454 2654
##   2024  250 2688
## 
## Outcome availability by age and year (unweighted):
## , , Observed = 0
## 
##       Age
## Year   45-49 50-54 55-64 65-75
##   2022    51   111   131   161
##   2024    25    34    93    98
## 
## , , Observed = 1
## 
##       Age
## Year   45-49 50-54 55-64 65-75
##   2022   287   356   845  1166
##   2024   323   347   879  1139

11.3 Inverse-probability weighting for observed screening outcomes

Inverse-probability weighting models the probability of an observed screening outcome using available demographic and socioeconomic variables. Observed responses receive the final survey weight multiplied by the inverse estimated observation probability. This sensitivity analysis addresses measured patterns in outcome availability; it cannot rule out bias from unmeasured missingness or differences between the yearly outcome definitions.

Missingness sensitivity with final raked weight
Year Original_pct Original_LCL Original_UCL IPW_pct IPW_LCL IPW_UCL
2022 64.03 61.76 66.30 63.31 60.89 65.73
2024 68.08 65.93 70.24 67.75 65.57 69.93 
## 
## Original percentage-point change: 4.06
## IPW-adjusted percentage-point change: 4.44
## 
## Observed-case inverse observation probability (weight multiplier):
##    Min. 1st Qu.  Median    Mean 3rd Qu.    Max. 
##   1.023   1.047   1.062   1.128   1.102   4.916
## 
## Number of complete screening outcomes: 5342

12 Interpretation and limitations

The primary results describe survey-weighted associations with screening, not causal relationships. The two survey years use CDC-derived screening indicators that are not perfectly interchangeable, and screening history is self-reported. Outcome nonresponse and complete-case regression may introduce selection bias. The inverse-probability analysis relies on assumptions about missing outcomes given the observed covariates; its confidence intervals do not include uncertainty from fitting the observation model. Results should not be interpreted as direct evidence of an effect of state policy changes.

13 Data and methods references

14 Session information

## R version 4.6.2 (2026-10-29)
## Platform: aarch64-apple-darwin23
## Running under: macOS Golden Gate 27.0
## 
## Matrix products: default
## BLAS:   /Library/Frameworks/R.framework/Versions/4.6/Resources/lib/libRblas.0.dylib 
## LAPACK: /Library/Frameworks/R.framework/Versions/4.6/Resources/lib/libRlapack.dylib;  LAPACK version 3.12.1
## 
## locale:
## [1] en_US.UTF-8/en_US.UTF-8/en_US.UTF-8/C/en_US.UTF-8/en_US.UTF-8
## 
## time zone: America/Chicago
## tzcode source: internal
## 
## attached base packages:
## [1] grid      stats     graphics  grDevices utils     datasets  methods  
## [8] base     
## 
## other attached packages:
## [1] knitr_1.52      survey_4.5      survival_3.8-12 Matrix_1.7-6   
## [5] haven_2.5.5    
## 
## loaded via a namespace (and not attached):
##  [1] vctrs_0.7.3       cli_3.6.6         rlang_1.3.0       xfun_0.62        
##  [5] DBI_1.3.0         mitools_2.7       forcats_1.0.1     jsonlite_2.0.0   
##  [9] glue_1.8.1        htmltools_0.5.9   sass_0.4.10       hms_1.1.4        
## [13] rmarkdown_2.32    evaluate_1.0.5    jquerylib_0.1.4   tibble_3.3.1     
## [17] fastmap_1.2.0     yaml_2.3.12       lifecycle_1.0.5   compiler_4.6.2   
## [21] Rcpp_1.1.2        pkgconfig_2.0.3   rstudioapi_0.19.0 lattice_0.23-1   
## [25] digest_0.6.39     R6_2.6.1          pillar_1.11.1     splines_4.6.2    
## [29] magrittr_2.0.5    bslib_0.12.0      tools_4.6.2       cachem_1.1.0