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Primary Care Physicians and Disparities in Colorectal Cancer Screening in the Elderly

Authors

  • Ashwani K. Singal M.D.,

    1. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
    2. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
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  • Yu-Li Lin M.S.,

    1. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
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  • Yong-Fang Kuo Ph.D.,

    1. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
    2. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
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  • Taylor Riall M.D., Ph.D.,

    1. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
    2. Department of Surgery, University of Texas Medical Branch, Galveston, TX
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  • James S. Goodwin M.D.

    Corresponding author
    1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
    • Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
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Address correspondence to James S. Goodwin, M.D., Sealy Center on Aging, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0177; e-mail: jsgoodwi@utmb.edu

Abstract

Objective

To examine whether having a primary care physician (PCP) is associated with reduced ethnic disparities for colorectal cancer (CRC) screening and whether clustering of minorities within PCPs contributes to the disparities.

Data Sources/Study Setting

Retrospective cohort study of Medicare beneficiaries age 66–75 in 2009 in Texas.

Study Design

The percentage of beneficiaries up to date in CRC screening in 2009 was stratified by race/ethnicity. Multilevel models were used to study the effect of having a PCP and PCP characteristics on the racial and ethnic disparities on CRC screening.

Data Collection/Extraction Methods

Medicare data from 2000 to 2009 were used to assess prior CRC screening.

Principal Findings

Odds of undergoing CRC screening were more than twice as high in patients with a PCP (OR = 2.05, 95 percent CI 2.03–2.07). After accounting for clustering and PCP characteristics, the black–white disparity in CRC screening rates almost disappears and the Hispanic–white disparity decreases substantially.

Conclusions

Ethnic disparities in CRC screening in the elderly are mostly explained by decreased access to PCPs and by clustering of minorities within PCPs less likely to screen any of their patients.

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