DISPARITIES IN COLORECTAL CANCER SCREENING: A GUIDELINE-BASED ANALYSIS OF ADHERENCE

Purpose: This study’s primary objective was to describe colorectal cancer (CRC) screening disparities using a guideline-derived definition of CRC screening adherence while controlling for confounding factors associated with CRC screening. Methods: This secondary data analysis of the 2000 National Health Interview Survey (NHIS) included 12,677 individuals age $50 years. The primary outcome assessed was adherence to CRC screening guidelines, defined as a sigmoidoscopy or proctoscopy within the last five years, colonoscopy within the last 10 years, or home fecal occult blood test within the last 12 months. Age, race/ethnicity, gender, physical disability, household income, insurance status, education level, marriage status, rural or urban geographic area, and family history of CRC were analyzed as covariates in a logistic regression model. We assessed the association between these socio-demographic variables and receipt of physician recommendation for CRC screening among those respondents not adherent to CRC screening recommendations. Results: In the multivariate model, the odds for being adherent with current CRC screening recommendations were lower for Hispanics (odds ratio [OR] 0.71, 95 % confidence interval [CI] 0.59–0.86) and African Americans (OR 0.82, 95 % CI 0.71–0.95) than for Whites. Residents of urban areas had higher odds (OR 1.19, 95 % CI 1.06–1.34) of being up-to-date than rural residents. Among subjects who were not up-to-date with CRC screening, similar disparities were noted in receipt of physician recommendation for CRC screening. Conclusions: Certain groups are at increased risk of not receiving CRC screening or recom-mendations for screening from their physi-cians. Interventions to reduce these disparities should be an integral part of overall efforts to improve CRC prevention and control. (Eth