Colonoscopist and Primary Care Physician Supply and Disparities in Colorectal Cancer Screening
Article first published online: 8 DEC 2011
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 3pt1, pages 1137–1157, June 2012
How to Cite
Benarroch-Gampel, J., Sheffield, K. M., Lin, Y.-L., Kuo, Y.-F., Goodwin, J. S. and Riall, T. S. (2012), Colonoscopist and Primary Care Physician Supply and Disparities in Colorectal Cancer Screening. Health Services Research, 47: 1137–1157. doi: 10.1111/j.1475-6773.2011.01355.x
- Issue published online: 8 MAY 2012
- Article first published online: 8 DEC 2011
- NIH. Grant Numbers: R01CA134275, K05CA134923, K07CA130983
- Cancer Prevention Research Institute of Texas. Grant Number: RP101207
- Colorectal cancer;
- cancer screening tests;
- health care disparities;
- primary care physicians;
To determine whether racial/ethnic disparities in colonoscopy use vary by physician availability.
We used 100 percent Texas Medicare claims data for 2003–2007.
We identified beneficiaries aged 66–79 in 2007, examined racial/ethnic differences in colonoscopy use from 2003 to 2007, and estimated the percentage of white, black, and Hispanic beneficiaries who underwent colonoscopy by level of physician availability and area income.
For the 974,879 beneficiaries, colonoscopy use was higher in whites (40.7 percent) compared to blacks (35.0 percent) and Hispanics (28.7 percent, p < .001). For whites, increasing availability of colonoscopists and primary care physicians (PCPs) was associated with higher colonoscopy use. For blacks and Hispanics, colonoscopy use was unchanged or decreased with increases in colonoscopist and PCP availability. In multilevel models, the odds of colonoscopy were 20 percent lower for blacks (OR 0.80, 95 percent CI 0.79–0.82) and 32 percent lower for Hispanics (OR 0.68, 95 percent CI 0.66–0.69) compared to whites; adjusting for availability of colonoscopists or PCPs did not attenuate racial/ethnic disparities. We found greater racial/ethnic disparities in areas with greater colonoscopist and PCP availability.
Greater area availability of colonoscopists and PCPs is associated with increased use of colonoscopy in whites but decreased use in minorities, resulting in larger racial/ethnic disparities.