Multilevel modeling of factors associated with racial and ethnic colorectal cancer disparities

Racial and ethnic disparities in morbidity and mortality rates of colorectal cancer are persistent, pervasive and poorly understood. Researchers generally approach understanding disparities through one of three perspectives: a clinical lens (e.g. risk differences); individual behaviors (e.g. screening, choices in treatment); or a broader social lens (e.g. access to care, insurance, institutional discrimination).

The author proposes a multilevel model designed to examine the interaction of both group- and individual-level factors on racial and ethnic disparities in morbidity and mortality rates. The resulting data analysis considers social context as well as individual and clinical demographics together to assess interactions among gender, race, age, geographic location, resource allocation and socioeconomic status among other variables to attempt to gain a more comprehensive understanding of the complexities of disparities. The model offers individuals, practitioners and policymakers evidence of multilevel effects, demonstrating the importance of designing interventions that consider multiple levels of interaction on health outcomes, including the interaction between individual behavior and social context.

The author discusses the challenges faced in the development and implementation of a multilevel model, as well as implications for screening and treatment education. In addition, the author proposes strategies for adapting messages to both high- and low-risk individuals and groups and promoting institutional and public health policies that encourage and reward efforts to reduce and eventually eliminate disparities in morbidity and mortality rates.