title: Persistent racial and ethnic disparities in up-to-date colorectal cancer testing in medicare enrollees.
abstract: OBJECTIVE
  To assess whether greater colonoscopy use among white as compared with nonwhite Medicare enrollees since Medicare established coverage for colorectal cancer (CRC) screening has been associated with a widening in white versus nonwhite disparities in up-to-date CRC testing status.
  
  
  METHODS
  Serial cross-sectional analysis of Medicare claims.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results (SEER) regions in nine states, representing 14% of the U.S. population.
  
  
  METHODS
  A 5% random sample of fee-for-service Medicare enrollees aged 70 to 79 within each 6-month period from mid-1995 through 2003.
  
  
  METHODS
  Trends in up-to-date status (having a fecal occult blood test (FOBT) claim in the prior year or a sigmoidoscopy or colonoscopy claim in the prior 5 years) according to race or ethnicity, estimated using repeated-measures logistic regression adjusting for age, sex, rural versus urban residence, income, comorbidity, and SEER region.
  
  
  RESULTS
  From mid-1995 through 2003, the adjusted percentage of enrollees that were up-to-date increased by a similar magnitude in whites (from 39.4% to 47.3%), blacks (from 29.0% to 38.1%), Asians and Pacific Islanders (from 33.1% to 41.8%), and Hispanics (from 23.7% to 33.2%). Although white versus nonwhite disparities in up-to-date status via colonoscopy widened, this was counterbalanced by narrowing white versus nonwhite disparities in up-to-date status via FOBT and sigmoidoscopy.
  
  
  CONCLUSIONS
  White versus nonwhite disparities in up-to-date CRC testing status in Medicare enrollees largely persisted through 2003.
authors.affiliation: Department of Family and Community Medicine, School of Medicine, University of California, Davis, Sacramento, California 95817, USA. Joshua.fenton@ucdmc.ucdavis.edu
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fenton
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.forename: Pamela
authors.initials: P
authors.lastname: Green
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
mesh_terms: D000368:Aged; D001213:Asian / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D009780:Occult Blood; D012424:Rural Population / Q000706:statistics & numerical data; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American