Multi-level Determinants of Colon Cancer Screening within Low-income, Urban Immigrant Latinos

Background: Latinos are the largest minority group in the US. Despite low incidence rates, Latinos are more likely to be diagnosed with late stage colorectal cancer and have lower screening rates than other groups. Objective: We evaluate the association of patient, health care structural, and area-level influences on colon cancer screening in Latinos utilizing free or low-cost community clinics. Methods: Data on screening rates and patient demographics were abstracted from a random sample of records of Latinos aged 50 and older who had attended the clinic for at least one year. Descriptions of the structural aspects of care were obtained from key informant interviews. Zip code-level data on area characteristics were obtained from the 2000 census. Logistic regression was used to examine specific factors associated with screening status. Screening was defined as having ever had FOBT, sigmoidoscopy or colonoscopy in the absence of symptoms. Results: A total of 723 patients were 50 and older with 17.6% ever having a colorectal cancer screening. Clinics with weekend hours (OR=5.2, 95% CI: 3.1-8.9) and no waiting list (OR=1.8, 95% CI: 1.0-3.1) were associated with patients ever being screened for colorectal cancer, controlling for covariates. In addition, Latinos who visited clinics in regions characterized by a low percentage of recent immigrants (OR=1.5, 95%CI: 1.0-2.5) tended to be associated with ever having a colon screening. Conclusions: The result of this analysis calls attention to the importance of available weekend hours and prompt appointments in community clinics for improving colon cancer screening rates in Latino immigrants.