Factors associated with suboptimal colorectal cancer screening in US immigrants.
BACKGROUND
Our objectives were to: (1) compare colorectal cancer screening (CRCS) among US born citizens (USBs), naturalized citizens (NACs), and noncitizens (NOCs) and (2) evaluate clinical factors and potential barriers associated with CRCS in these populations.


METHODS
Screening-eligible patients were identified from the 2007 California Health Interview Survey. Up-to-date CRCS was defined as a fecal occult blood test within 1 year, a sigmoidoscopy within 5 years, or a colonoscopy within 10 years. Using logistic regression, we determined the effects of immigrant status on CRCS. Stratified analyses based on location of residence, health insurance status, and English proficiency were conducted.


RESULTS
A total of 30,434 average-risk adults aged 50 years or older completed the survey. Only 67% of USBs, 61% of NACs, and 46% of NOCs underwent CRCS. Advanced age, male sex, high-income earners, nonsmokers, and those who were married or visited their physicians frequently were more likely to receive CRCS (all P < 0.05). Compared with USBs, both NACs and NOCs showed decreased odds of CRCS (odds ratio 0.88, 95% confidence interval, 0.74-1.06 and odds ratio 0.68, 95% confidence interval, 0.53-0.88, respectively; P = 0.011). Stratified analyses revealed that the associations between immigrants and decreased CRCS were more prominent for those who lived in rural areas, lacked insurance, or were not English proficient.


CONCLUSIONS
CRCS remains suboptimal, especially in new US immigrants. Improving health care access and mitigating language barriers may minimize this disparity.
Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada.
Neal C
NC
Shahidi
Babak
B
Homayoon
Winson Y
WY
Cheung
D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009780:Occult Blood; D016017:Odds Ratio; D018570:Risk Assessment; D012424:Rural Population; D012737:Sex Factors; D014481:United States; D014505:Urban Population