title: Reducing racial and ethnic disparities in colorectal cancer screening is likely to require more than access to care.
abstract: Colorectal endoscopy, an effective screening intervention for colorectal cancer, is recommended for people age fifty or older, or earlier for those at higher risk. Rates of colorectal endoscopy are still far below those recommended by the US Preventive Services Task Force. This study examined whether factors such as the supply of gastroenterologists and the proportion of the local population without health insurance coverage were related to the likelihood of having the procedure, and whether these factors explained racial and ethnic differences in colorectal endoscopy. We found evidence that improving access to health care at the county and individual levels through expanded health insurance coverage could improve colorectal endoscopy use but might not be sufficient to reduce racial and ethnic disparities in colorectal cancer screening. Policy action to address these disparities will need to consider other structural and cultural factors that may be inhibiting colorectal cancer screening.
authors.affiliation: Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA. james.stimpson@unmc.edu
authors.forename: Jim P
authors.initials: JP
authors.lastname: Stimpson
authors.forename: José A
authors.initials: JA
authors.lastname: Pagán
authors.forename: Li-Wu
authors.initials: LW
authors.lastname: Chen
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011315:Preventive Medicine / Q000592:standards / Q000639:trends; D015397:Program Evaluation; D011787:Quality of Health Care; D044469:Racial Groups / Q000706:statistics & numerical data; D018570:Risk Assessment; D014481:United States