Abstract
Background: The Medicare population has documented racial/ethnic disparities in colorectal cancer (CRC) screening, but it is unknown whether these disparities differ across geographic regions. Methods: Among Medicare enrollees within 8 US states, we ascertained up-to-date CRC screening on December 31, 2003 (fecal occult blood testing in the prior year or sigmoidoscopy or colonoscopy in the prior 5 years). Logistic regression models tested for regional variation in up-to-date status among white versus different nonwhite populations (blacks, Asian/Pacific Islanders [APIs], Hispanics). We estimated regression-adjusted region-specific prevalence of up-to-date status by race/ethnicity and compared adjusted white versus nonwhite up-to-date prevalence across regions by using generalized least squares regression. Results: White versus nonwhite up-to-date status varied significantly across regions for blacks (P =.01) and APIs (P <.001) but not Hispanics (P =.62). Whereas the white versus black differences in proportion up-to-date were greatest in Atlanta (Georgia), rural Georgia, and the San Francisco Bay Area of California (range, 10%-16% differences, blacks<whites); there were no significant white versus black differences in Connecticut, Seattle (Washington) or Iowa. Whereas APIs had significantly lower up-to-date prevalence than whites in Michigan and the California regions of San Francisco, Los Angeles, and San Jose (range, 4%-15% differences, APIs<whites), APIs in Hawaii had higher up-to-date status than whites (52% vs 38% P <.001). White versus Hispanic differences were substantial but homogeneous across regions (range, 8%-16% differences, Hispanics<whites). In contrast to nonwhites, there was little geographic variation in up-to-date status among whites. Conclusions: Significant geographic variation in up-to-date status among black and API Medicare enrollees is associated with heterogeneous racial/ethnic disparities for these groups across US regions.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1755-1763 |
| Number of pages | 9 |
| Journal | Cancer |
| Volume | 117 |
| Issue number | 8 |
| DOIs | |
| State | Published - Apr 15 2011 |
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Keywords
- cancer screening
- colorectal cancer
- disparities
- geography of health
- Medicare
ASJC Scopus subject areas
- Cancer Research
- Oncology
Cite this
Geographic variation of racial/ethnic disparities in colorectal cancer testing among medicare enrollees. / Semrad, Thomas; Tancredi, Daniel J; Baldwin, Laura Mae; Green, Pamela; Fenton, Joshua J.
In: Cancer, Vol. 117, No. 8, 15.04.2011, p. 1755-1763.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Geographic variation of racial/ethnic disparities in colorectal cancer testing among medicare enrollees
AU - Semrad, Thomas
AU - Tancredi, Daniel J
AU - Baldwin, Laura Mae
AU - Green, Pamela
AU - Fenton, Joshua J
PY - 2011/4/15
Y1 - 2011/4/15
N2 - Background: The Medicare population has documented racial/ethnic disparities in colorectal cancer (CRC) screening, but it is unknown whether these disparities differ across geographic regions. Methods: Among Medicare enrollees within 8 US states, we ascertained up-to-date CRC screening on December 31, 2003 (fecal occult blood testing in the prior year or sigmoidoscopy or colonoscopy in the prior 5 years). Logistic regression models tested for regional variation in up-to-date status among white versus different nonwhite populations (blacks, Asian/Pacific Islanders [APIs], Hispanics). We estimated regression-adjusted region-specific prevalence of up-to-date status by race/ethnicity and compared adjusted white versus nonwhite up-to-date prevalence across regions by using generalized least squares regression. Results: White versus nonwhite up-to-date status varied significantly across regions for blacks (P =.01) and APIs (P <.001) but not Hispanics (P =.62). Whereas the white versus black differences in proportion up-to-date were greatest in Atlanta (Georgia), rural Georgia, and the San Francisco Bay Area of California (range, 10%-16% differences, blacks
AB - Background: The Medicare population has documented racial/ethnic disparities in colorectal cancer (CRC) screening, but it is unknown whether these disparities differ across geographic regions. Methods: Among Medicare enrollees within 8 US states, we ascertained up-to-date CRC screening on December 31, 2003 (fecal occult blood testing in the prior year or sigmoidoscopy or colonoscopy in the prior 5 years). Logistic regression models tested for regional variation in up-to-date status among white versus different nonwhite populations (blacks, Asian/Pacific Islanders [APIs], Hispanics). We estimated regression-adjusted region-specific prevalence of up-to-date status by race/ethnicity and compared adjusted white versus nonwhite up-to-date prevalence across regions by using generalized least squares regression. Results: White versus nonwhite up-to-date status varied significantly across regions for blacks (P =.01) and APIs (P <.001) but not Hispanics (P =.62). Whereas the white versus black differences in proportion up-to-date were greatest in Atlanta (Georgia), rural Georgia, and the San Francisco Bay Area of California (range, 10%-16% differences, blacks
KW - cancer screening
KW - colorectal cancer
KW - disparities
KW - geography of health
KW - Medicare
UR - http://www.scopus.com/inward/record.url?scp=79953793593&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79953793593&partnerID=8YFLogxK
U2 - 10.1002/cncr.25668
DO - 10.1002/cncr.25668
M3 - Article
C2 - 21472723
AN - SCOPUS:79953793593
VL - 117
SP - 1755
EP - 1763
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 8
ER -