Using colorectal trends in the U.S. to identify unmet primary care needs of vulnerable populations.
BACKGROUND
Colorectal cancer screening (CRC) disparities have worsened in recent years.


OBJECTIVE
To examine progress toward Healthy People 2010 goals for CRC screening among ethnic/racial groups, including disaggregated Latino groups.


METHODS
Multivariate logistic regressions examined associations between ethnicity/race and primary outcomes of self-reported guideline-concordant CRC screenings considering time trends for 65,947 respondents of the Medical Expenditure Panel Survey from 2000 to 2007 age 50-years and older from six groups (non-Latino White, non-Latino Black, Puerto Rican, Cuban, Mexican, and Other Latino). We also tested for modification effects by education, income, and health insurance.


RESULTS
Most groups approached Healthy People 2010 CRC screening rate goals, including non-Latino Whites (47%), non-Latino Blacks (42%) and Puerto Ricans (40%), while Mexicans remained disparately lower (28%). Higher education, income and insurance coverage, partially attenuated this lower likelihood, but Mexican rates remained significantly lower than non-Latino Whites for receiving endoscopy in the past 5 years {OR(95% CI)=0.68(0.59-0.77)} and having received any CRC screening {0.70(0.62-0.79)}.


CONCLUSIONS
Among ethnic/racial groups examined, only Mexicans met healthcare disparity criteria in CRC screening. Findings suggest that healthcare equity goals can be attained if resources affecting continuity of care or ability to pay for preventive services are available, and targeted populations are adequately identified.
The Pennsylvania State University, Department of Health Policy and Administration, USA.
Patricia Y
PY
Miranda
Michelle
M
Johnson-Jennings
Wassim
W
Tarraf
Patricia
P
González
William A
WA
Vega
Hector M
HM
González
D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data* / Q000639:trends; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D019538:Health Care Surveys / Q000592:standards; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D040361:Healthy People Programs; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D009780:Occult Blood; D011320:Primary Health Care / Q000191:economics; D011933:Reagent Kits, Diagnostic; D012923:Social Class; D013997:Time Factors; D014481:United States; D016270:United States Agency for Healthcare Research and Quality; D035862:Vulnerable Populations / Q000208:ethnology / Q000706:statistics & numerical data
D011933:Reagent Kits, Diagnostic