Previous studies have indicated that Hispanics and African-Americans are less likely than whites to receive colon cancer screening exams. The authors postulated that one reason for this discrepancy is that these populations live in areas with limited availability of endoscopies.
A research team led by Dr. Jennifer Haas of Brigham and Women's Hospital and Harvard Medical School in Boston examined whether there was a relationship between the availability of endoscopies in an individual's area and a person's use of colon cancer screening, as well as the stage or extent of disease at diagnosis.
They analyzed data from the National Health Interview Survey (NHIS), in addition to data on colorectal cancer stage from the Surveillance, Epidemiology, and End Results (SEER) program, and Medicare. Haas and colleagues used Medicare claims to assess each county's capacity for providing endoscopies.
The researchers found that Hispanics lived in counties with an average capacity of 1,224 procedures per 100,000 individuals ages 50 and older. This compared to a capacity of 1,569 procedures for African-Americans and 1,628 for whites.
The researchers also found that individuals had a modest increase in colon cancer screening as the endoscopy capacity increased in their counties. As the number of endoscopies per 100,000 residents increased by 750, the odds of being screened increased by 4%, the researchers said.
The authors added that screening disparities diminished after adjusting for an area's endoscopy capacity, racial and ethnic composition, and the socioeconomic status of its residents. They also found that among patients who were diagnosed with colon cancer, those who lived in areas with less access to endoscopies were marginally less likely to be diagnosed at an earlier stage; this effect diminished for Hispanics compared with whites, but not for African-Americans.
Programs that try to address disparities in colon screening use or stage at diagnosis should not only consider improving screening capacity, but also should address improving access to information about the importance of colon screening, the authors noted.
By Brian Casey
AuntMinnie.com staff writer
April 12, 2010
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