Primary care physicians and disparities in colorectal cancer screening in the elderly.
OBJECTIVE
To examine whether having a primary care physician (PCP) is associated with reduced ethnic disparities for colorectal cancer (CRC) screening and whether clustering of minorities within PCPs contributes to the disparities.


METHODS
Retrospective cohort study of Medicare beneficiaries age 66-75 in 2009 in Texas.


METHODS
The percentage of beneficiaries up to date in CRC screening in 2009 was stratified by race/ethnicity. Multilevel models were used to study the effect of having a PCP and PCP characteristics on the racial and ethnic disparities on CRC screening.


METHODS
Medicare data from 2000 to 2009 were used to assess prior CRC screening.


RESULTS
Odds of undergoing CRC screening were more than twice as high in patients with a PCP (OR = 2.05, 95 percent CI 2.03-2.07). After accounting for clustering and PCP characteristics, the black-white disparity in CRC screening rates almost disappears and the Hispanic-white disparity decreases substantially.


CONCLUSIONS
Ethnic disparities in CRC screening in the elderly are mostly explained by decreased access to PCPs and by clustering of minorities within PCPs less likely to screen any of their patients.
Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0177, USA.
Ashwani K
AK
Singal
Yu-Li
YL
Lin
Yong-Fang
YF
Kuo
Taylor
T
Riall
James S
JS
Goodwin
D000367:Age Factors; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D015897:Comorbidity; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013781:Texas; D014481:United States