Understanding the factors underlying disparities in cancer screening rates using the Peters-Belson approach: results from the 1998 National Health Interview Survey.
BACKGROUND
Cancer screening rates vary substantially by race and ethnicity. We applied the Peters-Belson approach, often used in wage discrimination studies, to analyze disparities in cancer screening rates between different groups using the 1998 National Health Interview Survey.


METHODS
A regression model predicting the probability of getting screened is fit to the majority group and then used to estimate the expected values for minority group members had they been members of the majority group. The average difference between the observed and expected values for a minority group is the part of the disparity that is not explained by the covariates.


RESULTS
The observed disparities in colorectal cancer screening (5.88%) and digital rectal screening (8.54%) between white and black men were explained fully by the difference in their covariate distributions. Only half of the disparity in the observed screening rates (13.54% for colorectal and 17.47% for digital rectal) between white and Hispanic men was explained by the difference in covariates between the groups. The entire disparity observed in mammography screening rates for black and Hispanic women (2.71% and 6.53%, respectively) compared with white women was explained by the difference in covariate distributions.


CONCLUSIONS
We found that the covariates that explain the disparity in screening rates between the white and the black population do not explain the disparity between the white and the Hispanic population. Knowing how much of a health disparity is explained by measured covariates can be used to develop more effective interventions and policies to eliminate disparity.
Rao
R Sowmya
RS
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, Applied Research Program, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland 20892, USA.
Graubard
Barry I
BI
Breen
Nancy
N
Gastwirth
Joseph L
JL
D000328:Adult; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009309:National Center for Health Statistics, U.S.; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011203:Poverty / Q000208:ethnology; D011287:Prejudice; D011336:Probability; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data*; D001741:Black or African American