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Background African Americans have the highest incidence and mortality from colorectal cancer (CRC). Despite guidelines to initiate screening with colonoscopy at age 45 in African Americans, CRC incidence remains high in this group. Objective To examine rates and predictors of CRC screening uptake as well as time-toscreening in a population of African Americans and non-African Americans in a healthcare system that minimizes variations in insurance and access. Design Retrospective cohort study. Setting Greater Los Angeles Veterans Affairs (VA) Healthcare System. Patients Random sample (N=357) of patients eligible for initial CRC screening. Interventions NA. Main Outcome Measurements Uptake of any screening method, uptake of colonoscopy in particular, predictors of screening, and time-to-screening in African Americans and non-African Americans. Results The overall screening rate by any method was 50%. Adjusted rates for any screening were lower among African Americans than non-African Americans (42%v.58%; OR=0.49,95%CI=0.31–0.77). Colonoscopic screening was also lower in African Americans (11%v.23%; adjusted OR=0.43,95%CI=0.24–0.77). In addition to race, homelessness, lower service connectedness, taking more prescription drugs, and not seeing a primary care provider within two years of screening eligibility predicted lower uptake of screening. Time-to-screening colonoscopy screening was longer in African Americans (adjusted HR=0.43,95%CI=0.25–0.75). Limitations The sample may not be generalizeable. Conclusions We found marked disparities in CRC screening despite similar access to care across races. Despite current guidelines aimed to increase screening in African Americans, participation in screening remained low and use of colonoscopy was infrequent.

Low hemoglobin levels of primiparous women in this sample might indicate increased nutritional stress associated with first pregnancy.

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