title: The impact of medical tourism on colorectal screening among Korean Americans: A community-based cross-sectional study.
abstract: Colorectal cancer (CRC) remains the most commonly diagnosed cancer among Korean Americans (KAs) in part due to low screening rates. Recent studies suggest that some KA patients engage in medical tourism and receive medical care in their home country. The impact of medical tourism on CRC screening is unknown. The purpose of this paper was to 1) investigate the frequency of medical tourism, 2) examine the association between medical tourism and CRC screening, and 3) characterize KA patients who engage in medical tourism.
  
  
  
  This is a community-based, cross-sectional study involving self-administered questionnaires conducted from August 2013 to October 2013. Data was collected on 193 KA patients, ages 50-75, residing in the Seattle metropolitan area. The outcome variable is up-to-date with CRC screening, defined as having had a stool test (Fecal Occult Blood Test or Fecal Immunochemical Test) within the past year or a colonoscopy within 10 years. Predictor variables are socio-demographics, health factors, acculturation, knowledge, financial concerns for medical care costs, and medical tourism.
  
  
  
  In multi-variate modeling, medical tourism was significantly related to being up-to-date with CRC screening. Participants who engaged in medical tourism had 8.91 (95% CI: 3.89-23.89) greater odds of being up-to-date with CRC screening compared to those who did not travel for healthcare. Factors associated with engaging in medical tourism were lack of insurance coverage (P = 0.008), higher levels of education (P = 0.003), not having a usual place of care (P = 0.002), older age at immigration (P = 0.009), shorter years-of-stay in the US (P = 0.003), and being less likely to speak English well (P = 0.03).
  
  
  
  This study identifies the impact of medical tourism on CRC screening and characteristics of KA patients who report engaging in medical tourism. Healthcare providers in the US should be aware of the customary nature of medical tourism among KAs and consider assessing medical tests done abroad when providing cancer care.
  
  
  
  Not applicable.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Department of Health Services, University of Washington School of Public Health, 1100 Fairview Ave. N, M3-B232, Seattle, WA, 98109-1024, USA. lko@fredhutch.org.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Ko
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Department of Health Services, University of Washington School of Public Health, 1100 Fairview Ave. N, M3-B232, Seattle, WA, 98109-1024, USA.
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Taylor
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Jihye
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Wade K
authors.initials: WK
authors.lastname: Copeland
authors.affiliation: Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Joo Ha
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: National Asian Pacific Center on Aging, Seattle, WA, USA.
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Inadomi
mesh_terms: D001213:Asian; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening; D057193:Medical Tourism; D016017:Odds Ratio; D011159:Population Surveillance; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014861:Washington / Q000453:epidemiology
keywords: Colorectal cancer screening; Korean Americans; Medical tourism