title: Low uptake of colorectal cancer screening among African Americans in an integrated Veterans Affairs health care network.
abstract: BACKGROUND
  African Americans have the highest incidence and mortality from colorectal cancer (CRC). Despite guidelines to initiate screening with colonoscopy at age 45 in African Americans, the CRC incidence remains high in this group.
  
  
  OBJECTIVE
  To examine the rates and predictors of CRC screening uptake as well as time to screening in a population of African Americans and non-African Americans in a health care system that minimizes variations in insurance and access.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Greater Los Angeles Veterans Affairs (VA) Healthcare System.
  
  
  METHODS
  Random sample (N = 357) of patients eligible for initial CRC screening.
  
  
  METHODS
  Uptake of any screening method; uptake of colonoscopy, in particular; predictors of screening; and time to screening in African Americans and non-African Americans.
  
  
  RESULTS
  The overall screening rate by any method was 50%. Adjusted rates for any screening were lower among African Americans than non-African Americans (42% vs 58%; odds ratio [OR] 0.49; 95% confidence interval [CI], 0.31-0.77). Colonoscopic screening was also lower in African Americans (11% vs 23%; adjusted OR 0.43; 95% CI, 0.24-0.77). In addition to race, homelessness, lower service connectedness, taking more prescription drugs, and not seeing a primary care provider within 2 years of screening eligibility predicted lower uptake of screening. Time to screening colonoscopy was longer in African Americans (adjusted hazard ratio 0.43; 95% CI, 0.25-0.75).
  
  
  CONCLUSIONS
  The sample may not be generalizable.
  
  
  CONCLUSIONS
  We found marked disparities in CRC screening despite similar access to care across races. Despite current guidelines aimed at increasing CRC screening in African Americans, participation in screening remained low, and use of colonoscopy was infrequent.
authors.affiliation: Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA; UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, California, USA.
authors.forename: Folasade P
authors.initials: FP
authors.lastname: May
authors.affiliation: Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Erica G
authors.initials: EG
authors.lastname: Bromley
authors.affiliation: UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, California, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Reid
authors.affiliation: Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Baek
authors.affiliation: Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.affiliation: Department of Medicine, Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA; UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, California, USA.
authors.forename: Brennan M R
authors.initials: BM
authors.lastname: Spiegel
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data