Disparities in colorectal screening between US-born and foreign-born populations: evidence from the 2000 National Health Interview Survey.
BACKGROUND
Over 11% of the US population in 2002 was foreign born. Studies that have examined disparities of cancer screening often focus on racial/ethnicity differences without considering their origins. This study examines the disparities in colorectal cancer (CRC) screening between US- and foreign-born groups and explores factors associated with such disparities.


METHODS
Data were obtained from the 2000 National Health Interview Survey Cancer Control Module. Multivariate logistic models were used to compare the use of CRC screening among the foreign born and 4 US-born race/ethnicity subgroups while controlling for other factors that may affect such screening. Appropriate weighting procedures were employed to account for the complex design of the survey.


RESULTS
Compared with the US-born non-Hispanic Whites, the odds ratio of ever having had a colorectal screening for the US-born Hispanic, non-Hispanic Black, non-Hispanic other races groups, and the foreign-born group with 15 or more years of residency was 0.65, 0.77, 0.98, and 0.58, respectively. An even lower odds ratio (0.46) was found among the foreign-born group with a shorter duration of residency. We found that the rate of screening for foreign-born individuals with good socioeconomic status and/or with health insurance was significantly lower than that of the US-born with similar status, and the rate was not much different from that of US-born individuals in lower socioeconomic levels. Having a usual source of care was found to be the most important protective factor for the foreign-born group.


CONCLUSIONS
Foreign birth was associated with a lower rate of CRC screening. Future studies of health disparities should also consider immigration status.
Shih
Ya-Chen Tina
YC
Section of Health Services Research, Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA. yashih@mdanderson.org
Elting
Linda S
LS
Levin
Bernard
B
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States