Correlates of Colorectal Cancer Screening in California

Purpose: To identify the population characteristics correlated with utilization of colorectal cancer (CRC) screening and receiving doctor's recommendation for this screening among subjects =>50 years.

Methods: We analyzed data from the 2005 California Health Interview Survey (CHIS), a telephone-based survey of a representative sample of people aged =>50 years (n= 22,006). We analyzed the data to estimate the association between the outcome variables (utilization of CRC screening and receiving doctor's recommendation for CRC screening) and socio-demographic variables, reported health status, and reported having regular source of care.

Results: The sample included 22,006 adults of whom 43% were <=0 years, 19% were >75 years. Sixty percent were female. Seventy eight percent were white, 4% were black, 7% were Hispanic and 7% were Asian. Fair/poor health status was reported by 27%, and 95% reported having regular source of care. The majority of interviews were conducted in English (93%). Sixty four percent reported living at >300% above the federal poverty level (FPL). Female had lower odds to be screened than male. Respondents >56 years old and/or those who claimed to be at 300% above the FPL had higher odds to be screened; while those who did not have a usual source of care had lower odds to be screened. Females, as well as individuals between the ages of 56-60 had higher odds to receive a doctor's recommendation for screening. Individuals who were > 75 years of age, who were at <300% FPL and who had no usual source of health care had lower odds to receive a doctor's recommendation for screening. Conclusions: In contrast to their lower odds of CRC screening, females reported significantly higher odds of receiving physician recommendations for screening, as did those between the ages of 56-60. Conversely, individuals who were >75 years old, or who reported incomes <300% above the poverty level reported significantly lower recommendation rates. Two of the surprising and notable trends identified in the data relate to gender and age. The current results are consistent with previous CHIS and NHIS data finding that women are less likely to be screened for CRC. Nevertheless, it would appear from our study that California women now receive recommendations at a higher rate compared to men, perhaps in compensation for the now well-documented overall screening disparity. It was also apparent from the data that patients receive reduced recommendation rates for CRC once they surpass age 60.