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Geographic variation of racial/ethnic disparities in colorectal cancer testing among medicare enrollees
Author(s) -
Semrad Thomas J.,
Tancredi Daniel J.,
Baldwin LauraMae,
Green Pamela,
Fenton Joshua J.
Publication year - 2011
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.25668
Subject(s) - medicine , demography , pacific islanders , sigmoidoscopy , ethnic group , population , logistic regression , fecal occult blood , colorectal cancer , gerontology , health equity , cancer , colonoscopy , public health , environmental health , pathology , sociology , anthropology
BACKGROUND: The Medicare population has documented racial/ethnic disparities in colorectal cancer (CRC) screening, but it is unknown whether these disparities differ across geographic regions. METHODS: Among Medicare enrollees within 8 US states, we ascertained up‐to‐date CRC screening on December 31, 2003 (fecal occult blood testing in the prior year or sigmoidoscopy or colonoscopy in the prior 5 years). Logistic regression models tested for regional variation in up‐to‐date status among white versus different nonwhite populations (blacks, Asian/Pacific Islanders [APIs], Hispanics). We estimated regression‐adjusted region‐specific prevalence of up‐to‐date status by race/ethnicity and compared adjusted white versus nonwhite up‐to‐date prevalence across regions by using generalized least squares regression. RESULTS: White versus nonwhite up‐to‐date status varied significantly across regions for blacks ( P = .01) and APIs ( P < .001) but not Hispanics ( P = .62). Whereas the white versus black differences in proportion up‐to‐date were greatest in Atlanta (Georgia), rural Georgia, and the San Francisco Bay Area of California (range, 10%‐16% differences, blacks