Association of local capacity for endoscopy with individual use of colorectal cancer screening and stage at diagnosis

Authors

  • Jennifer S. Haas MD, MSPH,

    Corresponding author
    1. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
    • Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120-1613
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    • Fax: (617) 732-7072

  • Phyllis Brawarsky MPH,

    1. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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  • Aarthi Iyer MPH,

    1. Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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  • Garrett M. Fitzmaurice ScD,

    1. Laboratory for Psychiatric Biostatistics, McLean Hospital and Harvard Medical School, Boston, Massachusetts
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  • Bridget A. Neville MPH,

    1. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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  • Craig Earle MD, MSc,

    1. Health Services Research Program, Cancer Care Ontario and the Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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  • Celia Patricia Kaplan DrPH, MA

    1. Medical Effectiveness Research Center, Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
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Abstract

BACKGROUND:

Limited capacity for endoscopy in areas in which African Americans and Hispanics live may be a reason for persistent disparities in colorectal cancer (CRC) screening and stage at diagnosis.

METHODS:

The authors linked data from the National Health Interview Survey on the use of CRC screening and data from Surveillance, Epidemiology, and End Results-Medicare on CRC stage with measures of county capacity for colonoscopy and sigmoidoscopy (endoscopy) derived from Medicare claims.

RESULTS:

Hispanics lived in counties with less capacity for endoscopy than African Americans or whites (for National Health Interview Survey, an average of 1224, 1569, and 1628 procedures per 100,000 individuals aged ≥50 years, respectively). Individual use of CRC screening increased modestly as county capacity increased. For example, as the number of endoscopies per 100,000 residents increased by 750, the odds of being screened increased by 4%. Disparities in screening were mitigated or diminished by adjustment for area endoscopy capacity, racial/ethnic composition, and socioeconomic status. Similarly, among individuals with CRC, those who lived in counties with less endoscopy capacity were marginally less likely to be diagnosed at an early stage. Adjustment for area characteristics diminished disparities in stage for Hispanics compared with whites but not African Americans.

CONCLUSIONS:

Increasing the use of CRC screening may require interventions to improve capacity for endoscopy in some areas. The characteristics of the area where an individual resides may in part mediate disparities in CRC screening use for both African Americans and Hispanics, and disparities in cancer stage for Hispanics. Cancer 2010. © 2010 American Cancer Society.

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