Racial Disparity in CRC Screening Despite Similar Access

Laurie Barclay, MD

August 11, 2014

Colorectal cancer screening (CRC), particularly colonoscopy, is low in blacks, despite similar access to care across races, according to a Veterans Affairs (VA) healthcare system study published online March 25 and in the August issue of Gastrointestinal Endoscopy.

"African Americans have the highest incidence and mortality from [CRC]," write Folasade P. May, MD, Mphil, from the Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, California, and colleagues. "Despite guidelines to initiate screening with colonoscopy at age 45 in African Americans, the CRC incidence remains high in this group."

Blacks not only have the highest overall incidence of and mortality from CRC among racial groups but also have the highest incidence of advanced stage at presentation and the lowest survival rates. CRC incidence has dropped by 10% among whites in the last 30 years but remained unchanged among blacks during the same period.

The goal of this retrospective cohort study was to compare the rates and predictors of CRC screening uptake, as well as time to screening, between blacks and nonblacks. The Greater Los Angeles VA Healthcare System has minimal racial variations in insurance and healthcare access.

Using a random sample of 357 patients eligible for initial CRC screening, the investigators looked at use of colonoscopy, use of any screening method, predictors of screening, and time to screening in blacks and nonblacks.

For any screening method, the overall screening rate was 50%, but blacks had lower adjusted rates than nonblacks (42% vs 58%; odds ratio [OR], 0.49; 95% confidence interval [CI], 0.31 - 0.77).

Blacks also had lower rates of colonoscopic screening (11% vs 23%; adjusted OR, 0.43; 95% CI, 0.24 - 0.77), and time to screening colonoscopy was longer than in nonblacks (adjusted hazard ratio, 0.43; 95% CI, 0.25 - 0.75).

"We found marked disparities in CRC screening despite similar access to care across races," Dr. May said in a news release. "Participation in screening remained low and use of colonoscopy was infrequent despite current guidelines aimed at increasing CRC screening in African Americans."

Other predictors of lower screening uptake were homelessness, lower service connectedness, more prescription drug use, and not seeing a primary care provider within 2 years of screening eligibility.

Limitations of this study include a possible lack of generalizability to other study populations, particularly as the sample was predominantly male.

"When adjusting for race, homelessness, low service connectedness, and greater use of prescription drugs, the lack of a primary care visit within two years of CRC screening eligibility independently predicted low screening," Dr. May concluded in the release. "Notably, individuals with a primary care visit within two years of CRC screening eligibility were nearly four times more likely to have had at least on CRC screening test."

The National Institutes of Health supported this study. The study authors have disclosed no relevant financial relationships.

Gastrointest Endosc. 2014;80:291-298. Abstract

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