Abstract
Colorectal cancer is often diagnosed at a later stage in blacks. We wanted to know if racial differences existed in the use of tests for detection of colorectal cancer. A 5% random sample was obtained of all Medicare beneficiaries with Part B coverage, aged 65 years and older and classified as white or black race. The numbers of colonoscopies, flexible sigmoidoscopies, and barium enemas were determined from the Physician/Supplier file. Blacks were 18% less likely to receive colonoscopy and 39% less likely to receive flexible sigmoidoscopy after controlling for age, sex, income, and access to care in a multivariable logistic regression model. Barium enema was not significantly different between the races. Black men had 25% lower use of colonoscopy and 50% decreased use of flexible sigmoidoscopy. Blacks receive less colonoscopy and flexible sigmoidoscopy than whites. Black men are particularly vulnerable to the under-use of these tests.
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REFERENCES
Baquet CR, Commiskey P. Colorectal cancer epidemiology in minorities: A review. J Assoc Acad Minor Phys 10:51–58, 1999
Cancer Facts and Figures for African Americans 2000-2001. Atlanta, American Cancer Society, 2000
Dayal H, Polissar L, Yang CY, Dahlberg S. Race, socioeconomic status, and other prognostic factors for survival from colo-rectal cancer. J Chron Dis 40:857–864, 1987
Chen VW, Fenoglio-Preiser CM, Wickerham DL, Andrews P, Hunter C, Stemmermann G, Jackson JS, Edwards BK. Aggressiveness of colon carcinoma in blacks and whites. Cancer Epidemiol Biomarkers Prev 6:1087–1093, 1997
Screening for colorectal cancer—United States, 1997. MMWR Morb Mortal Wkly Rep 48:116–121, 1999
Hoffman-Goetz L, Breen NL, Meissner H. The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States. Ethnicity Dis 8:43–51, 1998
McMahon LF, Wolfe RA, Huang S, Tedeschi P, Manning W, Edlund MJ. Racial and gender variation in use of diagnostic colonic procedures in the Michigan Medicare population. Med Care 37:712–717, 1999
Eddy DM. Screening for colorectal cancer. Ann Int Med 113:373–384, 1990
Mandel JS, Bond JH, Church TR, Snover DC, Bradley M, Schuman LM, Ederer F. Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med 328:1365–1371, 1993
Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM. Screening sigmoidoscopy and colorectal mortality. J Natl Cancer Inst 84:1572–1575, 1992
Selby JV, Friedman GD, Quesenberry CP, Weiss NS. A casecontrol study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326:653–657, 1992
O'Brien MJ, Winawer SJ, Graham Zauber A, Gottlieb LS, Sternberg SS, Diaz B, Dickersin GR, Ewing S, Geller S, Kasimian D, Komorowski R, Szporn A, Workgroup at NPS. The National polyp study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology 98:371–379, 1990
Lieberman DA. Cost-effectiveness model for colon cancer screening. Gastroenterol 109:1781–1790, 1995
Winawer DJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, Woolf SH, Glick SN, Ganiats TG, Bond JH. Colorectal cancer screening: Clinical guidelines and rationale. Gastroenterol 112:594–642, 1997
Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterol 112:17–23, 1997
Sonnenberg A, Delco F, Inadomi JM. Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med 133:647–649, 2000
Guide to clinical preventive services. Report of the US Preventive Services Task Force. Baltimore, Williams & Wilkins, 1996
Current Procedure Terminology 1999. Chicago, American Medical Association, 1999
US Public Health Services. International Classification of Diseases, 9th revision: Clinical Modification. Los Angeles, PMIC, 1996
Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, Vladeck BC. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med 335:791–799, 1996
Burns RB, McCarthy EP, Freund KM, Marwill SL, Shwartz M, Ash A, Moskowitz MA. Black women receive less mammography even with similar use of primary care. Ann Intern Med 125:173–182, 1996
Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 341:1359–1367, 1999
Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med 341:1198–1205, 1999
Katz JN, Barrett J, Liang MH, Bacon AM, Kaplan H, Kieval RI, Lindsey SM, Roberts WN, Sheef DM, Spencer RT, Weaver AL, Baron JA. Sensitivity and positive predictive value of Medicare part B physician claims for rheumatologic diseases and procedures. Arthritis Rheum 40:1594–1600, 1997
Javitt JC, McBean M, DiPaolo F. Accuracy of coding in Medicare Part B claims. Arch Ophthalmol 111:605–607, 1993
Montano DE, Phillips WR. Cancer screening by primary care physicians: A comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health 85:795–800, 1995
Cooper GS, Yuan Z, Landefeld CS, Rimm AA. Surgery for colorectal cancer: race-related differences in rates and survival among Medicare beneficiaries. Am J Public Health 86:582–586, 1996
Lafata JE, Johnson CC, Ben-Menachem T, Morlock RJ. Sociodemographic differences in the receipt of colorectal cancer surveillance care following treatment with curative intent. Med Care 39:361–372, 2001
Healthy People 2010. Understanding and Improving Health. Washington, DC, Government Printing Office, 2000
Church JM. Complete colonoscopy: how often? And if not, why not? Am J Gastroenterol 89:556–560, 1994
Anderson JC, Gonzalez JD, Messina CR, Pollack BJ. Factors that predict incomplete colonoscopy: thinner is not always better. Amer J Gastroenterol 95:2784–2787, 2000
Freeman HP, Payne R. Racial injustice in health care. N Engl J Med 342:1045–1047, 2000
Sung JFC, Blumenthal DS, Coates RJ, Alema-Mensah E. Knowledge, beliefs, attitudes, and cancer screening among inner-city African-American women. J Natl Med Assoc 89:405–411, 1997
Robinson SB, Ashley M, Haynes MA. Attitudes of African Americans regarding screening for prostate cancer. J Natl Med Assoc 88:241–246, 1996
Codori AM, Petersen GM, Miglioretti DL, Boyd P. Health beliefs and endoscopic screening for colorectal cancer: Potential for cancer prevention. Prev Med 33:128–136, 2001
Morrison RS, Wallenstein S, Natale DK, Senzel RS, Huang L-L. “We don't carry that”—failure of pharmacies in predominantly nonwhite neighborhoods to stock opiod analgesics. N Engl J Med 342:1023–1026, 2000
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Richards, R.J., Reker, D.M. Racial Differences in Use of Colonoscopy, Sigmoidoscopy, and Barium Enema in Medicare Beneficiaries. Dig Dis Sci 47, 2715–2719 (2002). https://doi.org/10.1023/A:1021001121026
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DOI: https://doi.org/10.1023/A:1021001121026