title: The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: analysis of large sub populations.
abstract: BACKGROUND
  Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer.
  
  
  OBJECTIVE
  To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer.
  
  
  METHODS
  The study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.9 million members. Utilization of breast cancer (BC) and colorectal cancer (CC) screening were analyzed by socio-economic ranks (SERs), ethnicity (Arab vs non-Arab), immigration status and ownership of voluntarily supplemental health insurance (VSHI).
  
  
  RESULTS
  Data on 157,928 and 303,330 adults, eligible for BC and CC screening, respectively, were analyzed. Those having lower SER, Arabs, immigrants from Former Soviet Union countries and non-owners of VSHI performed fewer cancer screening examinations compared with those having higher SER, non-Arabs, veterans and owners of VSHI (p < 0.001). Logistic regression model for BC Screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab and having a lower SER. The model for CC screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. The model estimated for BC and CC screening among females revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant.
  
  
  CONCLUSIONS
  Patients from low socio-economic backgrounds, Arabs, immigrants and those who do not own supplemental insurance do fewer tests for early detection of cancer. These sub-populations should be considered priority populations for targeted intervention programs and improved resource allocation.
authors.affiliation: Quality Management in Health Care, Maccabi Healthcare Services, Tel-Aviv, Israel. rachel_m@mac.org.il
authors.forename: Rachel
authors.initials: R
authors.lastname: Wilf-Miron
authors.forename: Ronit
authors.initials: R
authors.lastname: Peled
authors.forename: Einat
authors.initials: E
authors.lastname: Yaari
authors.forename: Anna
authors.initials: A
authors.lastname: Vainer
authors.forename: Avi
authors.initials: A
authors.lastname: Porath
authors.forename: Ehud
authors.initials: E
authors.lastname: Kokia
mesh_terms: D000368:Aged; D018912:Arabs / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007348:Insurance, Health; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors