Anthony F Jerant1, Rose E Arellanes, Peter Franks. 1. Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA 95817, USA. afjerant@ucdavis.edu
Abstract
BACKGROUND: In the United States, Hispanics are less likely to undergo colorectal cancer (CRC) screening than non-Hispanic whites (whites). OBJECTIVE: To examine factors associated with disparities in CRC screening between whites and Hispanic national origin subgroups. DESIGN: Cross-sectional analysis of 1999-2005 Medical Expenditure Panel Survey data. PARTICIPANTS: Respondents aged >50 years self-identifying as non-Hispanic white (18,733) or Hispanic (3686)-the latter of Mexican (2779), Cuban (336), Puerto Rican (376), or Dominican (195) origin. MEASUREMENTS: Dependent variable: self-report of up to date CRC screening, defined as fecal occult blood testing within 2 years and/or lower endoscopy at any time. INDEPENDENT VARIABLES: ethnicity/race, country of origin, interview language, socio-demographics, and access to care. RESULTS: Unadjusted CRC screening rates were highest in whites [mean (standard error), 55.9 (0.6) %], and lowest in Dominicans [28.5 (4.2) %]. After demographic adjustment, CRC screening was significantly lower for Mexicans [adjusted odds ratio (95% confidence interval), 0.46 (0.40, 0.53), p < 0.001)], Puerto Ricans [0.65 (0.47, 0.91), p = 0.01], and Dominicans [0.30 (0.19, 0.45), p < 0.001] versus whites. With further adjustment for language, socioeconomic factors, and access, Hispanic/white disparities were not significant, while among Hispanics, Cubans were more likely to be screened [1.57 (1.15, 2.14), p = 0.01]. CONCLUSIONS: Factors associated with CRC screening disparities between Hispanics and non-Hispanic whites appear similar among Hispanic sub-groups. However, the relative contribution of these factors to disparities varies by Hispanic national origin group, suggesting a need for differing approaches to increasing screening for each group.
BACKGROUND: In the United States, Hispanics are less likely to undergo colorectal cancer (CRC) screening than non-Hispanic whites (whites). OBJECTIVE: To examine factors associated with disparities in CRC screening between whites and Hispanic national origin subgroups. DESIGN: Cross-sectional analysis of 1999-2005 Medical Expenditure Panel Survey data. PARTICIPANTS: Respondents aged >50 years self-identifying as non-Hispanic white (18,733) or Hispanic (3686)-the latter of Mexican (2779), Cuban (336), Puerto Rican (376), or Dominican (195) origin. MEASUREMENTS: Dependent variable: self-report of up to date CRC screening, defined as fecal occult blood testing within 2 years and/or lower endoscopy at any time. INDEPENDENT VARIABLES: ethnicity/race, country of origin, interview language, socio-demographics, and access to care. RESULTS: Unadjusted CRC screening rates were highest in whites [mean (standard error), 55.9 (0.6) %], and lowest in Dominicans [28.5 (4.2) %]. After demographic adjustment, CRC screening was significantly lower for Mexicans [adjusted odds ratio (95% confidence interval), 0.46 (0.40, 0.53), p < 0.001)], Puerto Ricans [0.65 (0.47, 0.91), p = 0.01], and Dominicans [0.30 (0.19, 0.45), p < 0.001] versus whites. With further adjustment for language, socioeconomic factors, and access, Hispanic/white disparities were not significant, while among Hispanics, Cubans were more likely to be screened [1.57 (1.15, 2.14), p = 0.01]. CONCLUSIONS: Factors associated with CRC screening disparities between Hispanics and non-Hispanic whites appear similar among Hispanic sub-groups. However, the relative contribution of these factors to disparities varies by Hispanic national origin group, suggesting a need for differing approaches to increasing screening for each group.
Authors: Anna P Schenck; Carrie N Klabunde; Joan L Warren; Sharon Peacock; William W Davis; Sarah T Hawley; Michael Pignone; David F Ransohoff Journal: Cancer Epidemiol Biomarkers Prev Date: 2007-10 Impact factor: 4.254
Authors: Michael Pignone; Melissa Rich; Steven M Teutsch; Alfred O Berg; Kathleen N Lohr Journal: Ann Intern Med Date: 2002-07-16 Impact factor: 25.391
Authors: Stacey A Fedewa; Douglas A Corley; Christopher D Jensen; Wei Zhao; Michael Goodman; Ahmedin Jemal; Kevin C Ward; Theodore R Levin; Chyke A Doubeni Journal: Am J Prev Med Date: 2017-04-17 Impact factor: 5.043
Authors: Alison T Brenner; Richard Hoffman; Andrew McWilliams; Michael P Pignone; Robert L Rhyne; Hazel Tapp; Mark A Weaver; Danelle Callan; Brisa Urquieta de Hernandez; Khalil Harbi; Daniel S Reuland Journal: Am J Prev Med Date: 2016-05-27 Impact factor: 5.043
Authors: Anthony Jerant; Richard L Kravitz; Nancy Sohler; Kevin Fiscella; Raquel L Romero; Bennett Parnes; Daniel J Tancredi; Sergio Aguilar-Gaxiola; Christina Slee; Simon Dvorak; Charles Turner; Andrew Hudnut; Francisco Prieto; Peter Franks Journal: Ann Fam Med Date: 2014 May-Jun Impact factor: 5.166
Authors: Christina M Getrich; Andrew L Sussman; Deborah L Helitzer; Richard M Hoffman; Teddy D Warner; Victoria Sánchez; Angélica Solares; Robert L Rhyne Journal: Qual Health Res Date: 2011-11-08