title: Risk of colorectal adenomas and advanced neoplasia in Hispanic, black and white patients undergoing screening colonoscopy.
abstract: BACKGROUND
  Racial and ethnic differences in the risk of premalignant colorectal neoplasia have not been extensively studied.
  
  
  OBJECTIVE
  To measure adenoma prevalence among asymptomatic white, black and Hispanic patients undergoing screening colonoscopy.
  
  
  METHODS
  In this cross sectional cohort study, data from individuals ≥50 years undergoing first-time colonoscopy since 2006 at a single tertiary-care medical centre were obtained from the electronic medical record. Adenoma prevalence among whites, blacks and Hispanics was calculated; multivariate Poisson and logistic regression were used to identify factors independently associated with adenoma rates and the presence of advanced adenomas.
  
  
  RESULTS
  We identified 5075 eligible subjects: 3542 (70%) whites, 942 (18%) Hispanics and 591 (12%) blacks. The mean age was 62.2 years with 58% women. At least one adenoma was detected in 19%, 22% and 26% of whites, Hispanics and blacks respectively (Hispanics vs. whites P = 0.09; blacks vs. whites P = 0.0001). Isolated proximal adenomas were present in 9% of whites, 11% of Hispanics (P = 0.03) and 11% of blacks (P = 0.03). In multivariate analyses, a higher rate of adenomas was present in Hispanics (RR: 1.37, 95% CI: 1.20-1.57) and blacks (RR: 1.76, 95% CI: 1.52-2.04) than whites. Hispanics and blacks also had an increased risk of advanced adenomas compared to whites (OR(Hispanics) : 2.25, 95% CI: 1.62-3.11; OR(blacks) : 1.91, 95% CI: 1.27-2.86).
  
  
  CONCLUSIONS
  Adenoma prevalence was higher in blacks and Hispanics than in whites. Both groups were at greater risk of having proximal adenomas in the absence of any distal pathology than whites, where these lesions would have only been detected by colonoscopy. Efforts to promote screening are necessary among diverse, under-represented populations.
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: B
authors.initials: B
authors.lastname: Lebwohl
authors.forename: K
authors.initials: K
authors.lastname: Capiak
authors.forename: A I
authors.initials: AI
authors.lastname: Neugut
authors.forename: F
authors.initials: F
authors.lastname: Kastrinos
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000208:ethnology*; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011230:Precancerous Conditions / Q000175:diagnosis / Q000208:ethnology; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data*