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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
3022.0: Monday, December 12, 2005 - 9:06 AM

Abstract #115056

What explains unequal treatment in physician recommendation of endoscopic screening for colorectal cancer?

Nasar U. Ahmed, PhD, MPS, Robert Stempel School of Public Health, Florida International University, 11200 SW 8th Street, Miami, FL 33199, 305-348-1093, ahmedn@fiu.edu, Ashar Ata, MBBS, MPH, Department of Surgery, Meharry Medical Colege, 1005 Dr. D. B. Todd Blvd, Nashville, TN 37208, Tabassum Z. Insaf, MBBS, MPH, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, and Steven C. Stain, MD, Department of Surgery, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Nashville, TN 37208.

Ethnic minorities and women carry a disproportionate burden of colorectal cancer (CRC). Despite the effectiveness of colorectal screening, screening remains low among these populations. Physician recommendation is the strongest determining factor for cancer screening. A sample of 5733 screening eligible aged >=50, with a physician visit within 12 months was used. Underlying factors associated with unequal physician recommendations were examined using stepwise logistic regression.

Results: About 26% received an endoscopic screening recommendation. Likelihood of receiving a recommendation was lower for Hispanics and Blacks as compared with Whites in all ages and both genders, especially for women. Hispanics were 34% and Blacks 28% less likely to receive a recommendation compared to Whites. When controlling for annual income, the difference decreased to 23% for Hispanics and 17% for Blacks, although the difference remained significant. Controlling for education reduced it to 19% for Hispanics, 18% for Blacks and statistical significance was lost. Controlling for both education and income reduced the difference to 10% for Hispanics, 13% for Blacks. Multivariate adjustment diminished the difference to zero for Hispanics and Blacks to 3%. Controlling for insurance and regular source of care, the difference remained significant. When education was added to the control variables, the differences lost statistical significance.

Implication: Differences in screening can be explained through access to care and socioeconomic characteristics, especially education. Interventions to increase screening rates should therefore be targeted at increasing physician sensitivity to reduce unequal recommendations for women and the underserved.

Learning Objectives:

Keywords: Health Disparities, Cancer Screening

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Cancer Screening

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA