Racial/ethnic disparities in cancer screening practices among low-income populations

Background: Cancer prevention programs have been focused on increasing screening rates among minority populations. However, low-income White populations in the United States have largely gone unrecognized in research efforts and policies addressing health care disparities.

Methods: Data came from the 2003 National Health Interview Survey (NHIS), a nationally representative cross-sectional household survey. NHIS data were collected through complex multistage sampling, and computer-assisted personal interviews were utilized. A sample of low-income individuals (i.e., less than 200% of the federal poverty level) with various racial/ethnic backgrounds was identified. Multiple logistic regression modeling was employed to determine the effect of race/ethnicity on timely utilization of Pap tests, mammograms, and colon cancer screenings, after controlling for various sociodemographic factors, including insurance status, education, poverty status, geographic region, age, sex, and marital status.

Results: Compared to Non-Hispanic Whites, Non-Hispanic Blacks were almost 2 times as likely to have received a timely Pap test (adjusted OR = 1.92; 95% CI, 1.53-2.40) and Hispanics were 18% less likely to have received a timely Pap test (adjusted OR = 0.82; 95% CI, 0.68-0.997). Compared to Whites, Blacks were 41% more likely to have received a timely mammogram (adjusted OR = 1.41; 95% CI, 1.14-1.75) and Hispanics were 25% more likely to have received a timely mammogram, however this was not statistically significant (adjusted OR = 1.25; 95% CI, 0.98-1.61). Finally, compared to Whites, Blacks were 25% more likely to have received a timely colorectal screening (adjusted OR = 1.25; 95% CI, 1.02-1.54), and Hispanics were 34% less likely to have received a timely colorectal screening (adjusted OR = 0.66; 95% CI, 0.51-0.86).

Conclusion: These results show that race/ethnicity disparities in access to cancer screening services remain even after controlling for possible confounders. However, these disparities are in the opposite direction from those habitually expected: low-income non-Hispanic Blacks are in fact more likely to obtain cancer screening procedures in a timely manner compared to low-income Non-Hispanic Whites and Hispanics. This study points out the need for greater awareness of health care disparities in low-income White populations who may share health and access risks with their poor minority counterparts. Research and intervention efforts are needed to improve cancer prevention behaviors, health care access, and outcomes for low-income populations, including those that may typically be neglected by current policies.