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Geographic variation of racial/ethnic disparities in colorectal cancer testing among medicare enrollees
Version of Record online: 10 JAN 2011
Copyright © 2011 American Cancer Society
Volume 117, Issue 8, pages 1755–1763, 15 April 2011
How to Cite
Semrad, T. J., Tancredi, D. J., Baldwin, L.-M., Green, P. and Fenton, J. J. (2011), Geographic variation of racial/ethnic disparities in colorectal cancer testing among medicare enrollees. Cancer, 117: 1755–1763. doi: 10.1002/cncr.25668
- Issue online: 6 APR 2011
- Version of Record online: 10 JAN 2011
- Manuscript Accepted: 18 AUG 2010
- Manuscript Revised: 29 JUL 2010
- Manuscript Received: 24 MAY 2010
- cancer screening;
- colorectal cancer;
- geography of health;
The Medicare population has documented racial/ethnic disparities in colorectal cancer (CRC) screening, but it is unknown whether these disparities differ across geographic regions.
Among Medicare enrollees within 8 US states, we ascertained up-to-date CRC screening on December 31, 2003 (fecal occult blood testing in the prior year or sigmoidoscopy or colonoscopy in the prior 5 years). Logistic regression models tested for regional variation in up-to-date status among white versus different nonwhite populations (blacks, Asian/Pacific Islanders [APIs], Hispanics). We estimated regression-adjusted region-specific prevalence of up-to-date status by race/ethnicity and compared adjusted white versus nonwhite up-to-date prevalence across regions by using generalized least squares regression.
White versus nonwhite up-to-date status varied significantly across regions for blacks (P = .01) and APIs (P < .001) but not Hispanics (P = .62). Whereas the white versus black differences in proportion up-to-date were greatest in Atlanta (Georgia), rural Georgia, and the San Francisco Bay Area of California (range, 10%-16% differences, blacks<whites); there were no significant white versus black differences in Connecticut, Seattle (Washington) or Iowa. Whereas APIs had significantly lower up-to-date prevalence than whites in Michigan and the California regions of San Francisco, Los Angeles, and San Jose (range, 4%-15% differences, APIs<whites), APIs in Hawaii had higher up-to-date status than whites (52% vs 38% P < .001). White versus Hispanic differences were substantial but homogeneous across regions (range, 8%-16% differences, Hispanics<whites). In contrast to nonwhites, there was little geographic variation in up-to-date status among whites.
Significant geographic variation in up-to-date status among black and API Medicare enrollees is associated with heterogeneous racial/ethnic disparities for these groups across US regions. Cancer 2011. © 2011 American Cancer Society.