title: Provider recommendation for colorectal cancer screening: examining the role of patients' socioeconomic status and health insurance.
abstract: BACKGROUND
  Provider recommendation for colorectal cancer (CRC) screening test has been shown as a strong predictor of patients' decision to be screened. Evidence of factors associated with provider recommendation remains limited and inconsistent. The present study sought to examine the association between provider recommendation for colorectal cancer screening and patients' socioeconomic status (SES) and insurance status using national survey data for 2005.
  
  
  METHODS
  Analyses were based on 2948 adult aged 50 and older who participated in the 2005 Health Information National Trend Survey (HINTS). Multivariate logistic regression models were used to determine whether the indicators of SES (income and educational level) and insurance status have any impact on provider recommendation.
  
  
  RESULTS
  Our study found a strong association between recall of health care provider recommendation and reported recent screening testing after controlling for other patient characteristics. When all the study population were included in the analysis, those who had lower than high school education and high school graduates were less likely to have received provider recommendation than those with higher than high school education (OR=0.49; 95%CI=0.32-0.73 and OR=0.60; 95%CI=0.47-0.78 respectively). Income and insurance were not significant predictors. Education remained significantly associated with provider recommendation when only those who had made one or more medical visits in the past year were included in the analyses.
  
  
  CONCLUSIONS
  Patient's educational level--but not income or insurance status--was related to provider recommendation for CRC screening. To increase awareness of colorectal cancer risks and the benefit of screening, health care providers need to make a concerted effort to recommend colorectal cancer screening to all relevant patients, regardless of socioeconomic status and other personal characteristics.
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA 30310, United States. jye@msm.edu
authors.forename: Jiali
authors.initials: J
authors.lastname: Ye
authors.forename: Zhiheng
authors.initials: Z
authors.lastname: Xu
authors.forename: Oluranti
authors.initials: O
authors.lastname: Aladesanmi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012959:Socioeconomic Factors