Explaining disparities in colorectal cancer screening among five Asian ethnic groups: A population-based study in California

Abstract

BackgroundData from the California Health Interview Survey (CHIS) indicate that levels and temporal trends in colorectal cancer (CRC) screening prevalence vary among Asian American groups; however, the reasons for these differences have not been fully investigated.MethodsUsing CHIS 2001, 2003 and 2005 data, we conducted hierarchical regression analyses progressively controlling for demographic characteristics, English proficiency and access to care in an attempt to identify factors explaining differences in screening prevalence and trends among Chinese, Filipino, Vietnamese, Korean and Japanese Americans (N = 4,188).ResultsAfter controlling for differences in gender and age, all Asian subgroups had significantly lower odds of having ever received screening in 2001 than the reference group of Japanese Americans. In addition, Korean Americans were the only subgroup that had a statistically significant decline in screening prevalence from 2001 to 2005 compared to the trend among Japanese Americans. After controlling for differences in education, marital status, employment status and federal poverty level, Korean Americans were the only group that had significantly lower screening prevalence than Japanese Americans in 2001, and their trend to 2005 remained significantly depressed. After controlling for differences in English proficiency and access to care, screening prevalences in 2001 were no longer significantly different among the Asian subgroups, but the trend among Korean Americans from 2001 to 2005 remained significantly depressed. Korean and Vietnamese Americans were less likely than other groups to report a recent doctor recommendation for screening and more likely to cite a lack of health problems as a reason for not obtaining screening.ConclusionsDifferences in CRC screening trends among Asian ethnic groups are not entirely explained by differences in demographic characteristics, English proficiency and access to care. A better understanding of mutable factors such as rates of doctor recommendation and health beliefs will be crucial for designing culturally appropriate interventions to promote CRC screening.

Temporal Trends in Colorectal Cancer Screening among Asian Americans

“…Our findings of lower colorectal cancer screening among AAs compared with NHW, in unadjusted but not adjusted analyses of CHIS data, are consistent with a previous report and suggest that acculturation, health utilization, and demographic factors account for these differences (22). Studies examining reasons for not being screened among AAs report that lack of awareness and not having symptoms/problems as the most common reasons; foreign-born AA were especially prone to view screening as response to symptoms/problems as opposed to a preventive measure (22,23).…”

“…A substantial percentage of AA (particularly Korean and Vietnamese) either had no insurance or Medicaid insurance where colorectal cancer screening rates are low (24), which may also contribute to lower colorectal cancer screening in these groups (5). However, not having insurance or a doctor was infrequently cited as reasons for not receiving screening among AA (22), suggesting that more nuanced interactions between health care and cultural factors may also play a role. AA may seek health care from traditional practitioners or physicians that speak the same language, who may be less likely to recommend colorectal cancer screening (25).…”

“…Studies examining reasons for not being screened among AAs report that lack of awareness and not having symptoms/problems as the most common reasons; foreign-born AA were especially prone to view screening as response to symptoms/problems as opposed to a preventive measure (22,23). A substantial percentage of AA (particularly Korean and Vietnamese) either had no insurance or Medicaid insurance where colorectal cancer screening rates are low (24), which may also contribute to lower colorectal cancer screening in these groups (5).…”

The Role of Physician Recommendation in Colorectal Cancer Screening Receipt Among Immigrant Chinese Americans

“…Regular CRC screening can detect and remove precursor lesions or find early stage CRC that can be cured. However, receipt of CRC screening remains suboptimal, particularly among Asian Americans [2][3][4][5][6]. Chinese Americans, the largest Asian American group, have lower rates of CRC screening than non-Hispanic Whites, African Americans and Latinos [6,7].…”

Motivating Underserved Vietnamese Americans to Obtain Colorectal Cancer Screening: Evaluation of a Culturally Tailored DVD Intervention

“…Tu and colleagues (2010), for example, found certain sociodemographic and health accessibility variables to correlate with low adherence to CRC screening guidelines: male gender, lack of health insurance, infrequent recent medical visits, and no assigned primary care provider. Related to health accessibility issues, Maxwell, Crespi, Antonio, and Lu (2010) found Vietnamese to be less likely than other Asian Americans with the exception of Korean Americans to report a recent doctor's recommendation for screening. Maxwell and colleagues explained that that finding may be due to lack of health insurance or minimal English proficiency, each of which limits access to primary physicians.…”