​The objective of the study was to investigate the potential factors across urban-rural groups on the usage of colorectal cancer screening. 

A total of 38,505 adults (aged ≥40 years) were selected from the 2009 California Health Interview Survey (CHIS) data. The weighted generalized linear mixed-model (WGLIMM) was used to deal with this hierarchical structure data. The overall prevalence of CRC screening was 48.1 percent while the prevalence in four residence groups ― urban, second city, suburban, and town/rural ― were 45.8 percent, 46.9 percent, 53.7 percent and 50.1 percent, respectively.

The results of WGLIMM analysis showed that there was residence effect. Residence groups had significant interactions with gender, age group, education level, and employment status. Multiple logistic regression analysis revealed that age, race, marital status, education level, employment stats, binge drinking, and smoking status were associated with CRC screening.

Stratified by residence regions, age and poverty level showed associations with CRC screening in all four residence groups. Education level was positively associated with CRC screening in second city and suburban. Infrequent binge drinking was associated with CRC screening in urban and suburban; while current smoking was a protective factor in urban and town/rural groups.