Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

Abstract

OBJECTIVES:We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS:The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response rate: 73% for Blacks and 89% for Whites). CRCS adherence and race were obtained through surveys and supplemented with administrative data. Logistic regressions estimated the contribution of demographic, health, cognitive, and environmental factors to racial disparities in adherence to CRCS guidelines. RESULTS: In unadjusted analyses, Blacks had slightly lower rates of adherence to CRCS guidelines than Whites (72% versus 77%, p<0.05). This racial disparity in CRCS adherence was explained by race differences in demographic, health, and environmental factors but not by cognitive factors. Tests for interactions revealed that the association of race with adherence varied significantly across levels of income, education, and marital status. In particular, among those who were married with higher levels of education, CRCS adherence was significantly higher for Whites; whereas among those who were unmarried, with low levels of education, adherence was significantly higher for Blacks. CONCLUSION: We found that disparities in CRCS are greatly attenuated in the VA system and both Whites and Blacks have substantially higher rates of CRCS than the national average. These results point to the success of the VA at implementing CRCS system-wide. Our findings also suggest additional initiatives may be needed for unmarried low income white men and higher income black men. These disparities are partially attributable to lower rates of CRC screening (CRCS) by Blacks, 3-5 which has been shown to significantly reduce CRC mortality. [6][7][8][9] To understand what factors contribute to CRCS adherence, researchers have drawn on health behavior theories and have examined such factors as cognitions about screening, social and medical environmental factors, and demographic and health-related factors. [10][11][12] Few studies, however, have explored the extent to which racial disparities in adherence to CRCS are a function of these underlying factors, leaving unanswered questions about the best approaches to promote screening among populations with greater disease burden. [13][14][15][16][17][18][19][20] This study contributes to the broader literature on race differences in CRCS by examining the relative contribution of demographic and health factors, cognitive factors, and environmental factors to racial disparities in CRCS in a nationally representative survey of Veterans Health Affairs (VHA) patients aged 50-75.The VHA is a particularly interesting system within which to examine racial disparities in CRCS because it provides equal access to care to all qualifying veterans, and mandates that all patients be assigned to a primary care provider, both of which diminish barriers to screening that might disproportionally affect r...

Trends in anemia management in lung and colon cancer patients in the US Department of Veterans Affairs, 2002–2008

“…Finally, we found that African Americans with lung cancer (but not those with colon cancer) were less likely to receive ESA treatment. Race/ethnic differences in processes of care and treatment observed in other populations have often, but not always, been found to be absent or attenuated in VA facilities [36][37][38][39][40][41][42]. We don't know whether the difference was due to unobserved clinical factors, patient preference for other treatments, access issues, or other reasons, and therefore, we cannot make any judgments about its appropriateness.…”

Racial differences of colorectal cancer in a single institution in Northeast Louisiana primarily serving the underserved population

“…A sub-analysis in that study pointed to the targeting of screening efforts on unmarried, low income white men and higher income black men whose screening rates were low. 9 Decreasing family income was associated with decreasing colorectal cancer screening rate. 10 This study and its conclusions are limited by its small sample drawn from a single center and the retrospective nature of its design.…”

“…For example, a recently published study by Boehmer et al 8 reported that, after adjusting for confounders, there were no racial/ethnic differences in timely one-year CRC screening. Burgess et al 9 found that health disparities in CRC screening are greatly attenuated in the Veteran Affairs system where both Whites and Blacks have substantially higher rates of screening than the national average. A sub-analysis in that study pointed to the targeting of screening efforts on unmarried, low income white men and higher income black men whose screening rates were low.…”

Capsule Commentary on Kaplan et al., Reducing Racial/Ethnic Disparities in Diabetes: The Coached Care (R2D2C2) Project

“…O ne of the most troubling aspects of US medicine is the level of disparities in health and healthcare outcomes, [1][2][3] While previous work has generally focused on one or two potential contributors, the paper by Kaplan et al examines a myriad of patient, provider and system characteristics to explore the source of disparities in diabetes control among Mexican-Americans. 4 The differences in glycosylated hemoglobin seen between Vietnamese-Americans, non-Hispanic whites and MexicanAmericans were explained by differences in gender, age, duration of diabetes, education and income level and insurance status.…”