Racial and Ethnic Disparities in Cancer Screening

The Importance of Foreign Birth as a Barrier to Care

Authors

  • Mita Sanghavi Goel MD,

    Corresponding author
    1. Received from the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School (MSG, CCW, EPM, RBD, QN-M, RSP), Boston, Mass.
      Address correspondence and requests for reprints to Dr. Goel: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 (email: mgoel@caregroup.harvard.edu).
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  • Christina C. Wee MD, MPH,

    1. Received from the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School (MSG, CCW, EPM, RBD, QN-M, RSP), Boston, Mass.
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  • Ellen P. McCarthy PhD, MPH,

    1. Received from the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School (MSG, CCW, EPM, RBD, QN-M, RSP), Boston, Mass.
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  • Roger B. Davis ScD,

    1. Received from the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School (MSG, CCW, EPM, RBD, QN-M, RSP), Boston, Mass.
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  • Quyen Ngo-Metzger MD, MPH,

    1. Received from the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School (MSG, CCW, EPM, RBD, QN-M, RSP), Boston, Mass.
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  • Russell S. Phillips MD

    1. Received from the Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School (MSG, CCW, EPM, RBD, QN-M, RSP), Boston, Mass.
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Address correspondence and requests for reprints to Dr. Goel: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 (email: mgoel@caregroup.harvard.edu).

Abstract

CONTEXT:  Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace.

OBJECTIVE:  To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening.

DESIGN, SETTING, AND SUBJECTS:  Cross-sectional study using 1998 data from the National Health Interview Survey.

MAIN OUTCOME MEASURES:  Completion of cervical, breast, or colorectal cancer screening.

RESULTS:  Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82), Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents.

CONCLUSION:  Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born.

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