Race and Colorectal Cancer Disparities: Health-Care Utilization vs Different Cancer Susceptibilities

Laiyemo, Adeyinka O.; Doubeni, Chyke A.; Pinsky, Paul F.; Doria-Rose, V. Paul; Bresalier, Robert S.; Lamerato, Lois; Crawford, E. David; Kvale, Paul A.; Fouad, Mona N.; Hickey, Tom; Riley, Thomas L.; Weissfeld, Joel L.; Schoen, Robert E.; Marcus, Pamela M.; Prorok, Philip C.; Berg, Christine D.

doi:10.1093/jnci/djq068

Cited by 191 publications

(167 citation statements)

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“…Population differences have been observed in many human complex traits, including disease susceptibility, 29,30 drug sensitivity 31,32 and gene expression. [6][7][8] Genetic polymorphisms have undergone extensive evaluation for their potential role in these observed expression may contribute to observed population differences in mRNA expression levels and possibly other complex human traits.…”

Section: Discussionmentioning

confidence: 99%

Population differences in microRNA expression and biological implications

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Population differences in microRNA expression and biological implications

et al. 2011

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“…Underutilization of screening in some racial/ethnic groups contributes to disparities in CRC death rates, [11][12][13][14][15][16] particularly for blacks, who have the highest CRC mortality rates in the US. 17,18 These screening disparities may be related to lack of awareness or acceptance, poor patient-physician communication, economic and structural barriers such as lack of health insurance coverage or usual place of medical care.…”

Section: Introductionmentioning

confidence: 99%

Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System

et al. 2016

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BACKGROUND: Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. OBJECTIVE: To examine the association between race/ ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program. DESIGN: Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). SUBJECTS: A total of 868,934 screen-eligible individuals 51-74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004)(2005)(2006), 654,633 during the first 3 years after implementation (2007)(2008)(2009), and 665,268 in the period from 4 to 7 years (2010-2013) after program implementation. INTERVENTION: A comprehensive system-wide longterm effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits. MAIN MEASURES: Differences over time and by race/ ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ ethnicity categories included non-Hispanic white, nonHispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races. KEY RESULTS: From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02-1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96-0.97). There were also substantial improvements in timely follow-up of positive screening results. CONCLUSIONS: In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.

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“…It is the only gastrointestinal cancer that has been shown to be amenable to screening in randomized control trials [14,15]. However, blacks are less likely to be screened [10,11] or to have optimal diagnostic follow-up after an abnormal screening [16]. Studies have also suggested that blacks tend to receive substandard cancer care when compared to whites [17] with reduction and elimination of black-white differences in survival when equitable treatment was received by patients regardless of race-ethnicities [18,19].…”

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confidence: 99%