Factors associated with Hispanic/non-Hispanic white colorectal cancer screening disparities

Anthony F Jerant, Rose E. Arellanes, Peter Franks

Research output: Contribution to journalArticle

24 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1241-1245
Number of pages5
JournalJournal of General Internal Medicine
Volume23
Issue number8
DOIs
StatePublished - Aug 2008

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Early Detection of Cancer
Hispanic Americans
Colorectal Neoplasms
Language
Demography
Occult Blood
Health Expenditures
Self Report
Endoscopy
Cross-Sectional Studies
Odds Ratio
Confidence Intervals
Interviews

Keywords

  • Colorectal neoplasms
  • Hispanic Americans
  • Mass screening
  • Quality of health care
  • Socioeconomic factors

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Factors associated with Hispanic/non-Hispanic white colorectal cancer screening disparities. / Jerant, Anthony F; Arellanes, Rose E.; Franks, Peter.

In: Journal of General Internal Medicine, Vol. 23, No. 8, 08.2008, p. 1241-1245.

Research output: Contribution to journalArticle

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title = "Factors associated with Hispanic/non-Hispanic white colorectal cancer screening disparities",
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.",
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N2 - 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.

AB - 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.

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KW - Hispanic Americans

KW - Mass screening

KW - Quality of health care

KW - Socioeconomic factors

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