Original Research

Journal of General Internal Medicine

, Volume 26, Issue 3, pp 251-258

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

  • Diana J. BurgessAffiliated withCenter for Chronic Disease Outcomes Research, Minneapolis VA Medical CenterDepartment of Medicine, University of Minnesota Email author 
  • , Michelle van RynAffiliated withDepartment of Family Medicine and Community Health and Division of Epidemiology, University of Minnesota
  • , Joseph GrillAffiliated withCenter for Chronic Disease Outcomes Research, Minneapolis VA Medical Center
  • , Siamak NoorbaloochiAffiliated withCenter for Chronic Disease Outcomes Research, Minneapolis VA Medical CenterDepartment of Medicine, University of Minnesota
  • , Joan M. GriffinAffiliated withCenter for Chronic Disease Outcomes Research, Minneapolis VA Medical CenterDepartment of Medicine, University of Minnesota
  • , Jennifer RicardsAffiliated withThomson Reuters, Healthcare and Science
  • , Sally W. VernonAffiliated withDivision of Health Promotion and Behavioral Sciences, University of Texas-Houston School of Public Health
  • , Deborah A. FisherAffiliated withDurham Veterans Affairs Medical Center and Duke University Medical Center
  • , Melissa R. PartinAffiliated withCenter for Chronic Disease Outcomes Research, Minneapolis VA Medical CenterDepartment of Medicine, University of Minnesota

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Abstract

Objectives

We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS).

Methods

The sample included 328 Black and 1827 White patients age 50–75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response rate: 73% for Blacks and 89% for Whites). CRCS adherence and race were obtained through surveys and supplemented with administrative data. Logistic regressions estimated the contribution of demographic, health, cognitive, and environmental factors to racial disparities in adherence to CRCS guidelines.

Results

In unadjusted analyses, Blacks had slightly lower rates of adherence to CRCS guidelines than Whites (72% versus 77%, p < 0.05). This racial disparity in CRCS adherence was explained by race differences in demographic, health, and environmental factors but not by cognitive factors. Tests for interactions revealed that the association of race with adherence varied significantly across levels of income, education, and marital status. In particular, among those who were married with higher levels of education, CRCS adherence was significantly higher for Whites; whereas among those who were unmarried, with low levels of education, adherence was significantly higher for Blacks.

Conclusion

We found that disparities in CRCS are greatly attenuated in the VA system and both Whites and Blacks have substantially higher rates of CRCS than the national average. These results point to the success of the VA at implementing CRCS system-wide. Our findings also suggest additional initiatives may be needed for unmarried low income white men and higher income black men.

KEY WORDS

colorectal cancer cancer screening disparities minority health Veterans