title: Race and Prevalence of Large Bowel Polyps Among the Low-Income and Uninsured in South Carolina.
abstract: BACKGROUND
  Compared to whites, blacks have higher colorectal cancer incidence and mortality rates and are at greater risk for early-onset disease. The reasons for this racial disparity are poorly understood, but one contributing factor could be differences in access to high-quality screening and medical care.
  
  
  OBJECTIVE
  The present study was carried out to assess whether a racial difference in prevalence of large bowel polyps persists within a poor and uninsured population (n = 233, 124 blacks, 91 whites, 18 other) undergoing screening colonoscopy.
  
  
  METHODS
  Eligible patients were uninsured, asymptomatic, had no personal history of colorectal neoplasia, and were between the ages 45-64 years (blacks) or 50-64 years (whites, other). We examined the prevalence of any adenoma (conventional, serrated) and then difference in adenoma/polyp type by race and age categories.
  
  
  RESULTS
  Prevalence for ≥1 adenoma was 37 % (95 % CI 31-43 %) for all races combined and 36 % in blacks <50 years, 38 % in blacks ≥50 years, and 35 % in whites. When stratified by race, blacks had a higher prevalence of large conventional proximal neoplasia (8 %) compared to whites (2 %) (p value = 0.06) but a lower prevalence of any serrated-like (blacks 18 %, whites 32 %; p value = 0.02) and sessile serrated adenomas/polyps (blacks 2 %, whites 8 % Chi-square p value; p = 0.05).
  
  
  CONCLUSIONS
  Within this uninsured population, the overall prevalence of adenomas was high and nearly equal by race, but the racial differences observed between serrated and conventional polyp types emphasize the importance of taking polyp type into account in future research on this topic.
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA. Wallack@musc.edu.|Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA. Wallack@musc.edu.
authors.forename: Kristin
authors.identifier: http://orcid.org/0000-0002-4297-9064
authors.initials: K
authors.lastname: Wallace
authors.affiliation: Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA.|Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Brandt
authors.affiliation: Gibbs Cancer Center and Research Institute, Spartanburg Regional Healthcare System, Spartanburg, SC, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Bearden
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
authors.forename: Bridgette F
authors.initials: BF
authors.lastname: Blankenship
authors.affiliation: Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA.
authors.forename: Renay
authors.initials: R
authors.lastname: Caldwell
authors.affiliation: Gibbs Cancer Center and Research Institute, Spartanburg Regional Healthcare System, Spartanburg, SC, USA.
authors.forename: James
authors.initials: J
authors.lastname: Dunn
authors.affiliation: Gibbs Cancer Center and Research Institute, Spartanburg Regional Healthcare System, Spartanburg, SC, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hegedus
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.|Department of Gastroenterology, Center for Digestive Disease, MUSC, Charleston, SC, USA.
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Hoffman
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
authors.forename: Courtney H
authors.initials: CH
authors.lastname: Marsh
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Marsh
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.|Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
authors.forename: Cathy L
authors.initials: CL
authors.lastname: Melvin
authors.affiliation: Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA.
authors.forename: March E
authors.initials: ME
authors.lastname: Seabrook
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Sterba
authors.affiliation: Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Stinson
authors.affiliation: Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Thibault
authors.affiliation: Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA.
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Berger
authors.affiliation: Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.|Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis / Q000191:economics / Q000208:ethnology*; D001741:Black or African American; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000191:economics / Q000208:ethnology*; D003111:Colonic Polyps / Q000175:diagnosis / Q000191:economics / Q000208:ethnology*; D003113:Colonoscopy; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology*; D008875:Middle Aged; D011203:Poverty / Q000191:economics / Q000208:ethnology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D044465:White People
keywords: Colorectal adenomas; Race; Screening; Serrated polyps; Socioeconomic status