Disparities in colorectal cancer screening: A guideline-based analysis of adherence

Purpose: This study's primary objective was to describe colorectal cancer (CRC) screening disparities using a guideline-derived definition of CRC screening adherence while controlling for confounding factors associated with CRC screening. Methods: This secondary data analysis of the 2000 National Health Interview Survey (NHIS) included 12,677 individuals age ≥50 years. The primary outcome assessed was adherence to CRC screening guidelines, defined as a sigmoidoscopy or proctoscopy within the last five years, colonoscopy within the last 10 years, or home fecal occult blood test within the last 12 months. Age, race/ethnicity, gender, physical disability, household income, insurance status, education level, marriage status, rural or urban geographic area, and family history of CRC were analyzed as covariates in a logistic regression model. We assessed the association between these sociodemographic variables and receipt of physician recommendation for CRC screening among those respondents not adherent to CRC screening recommendations. Results: In the multivariate model, the odds for being adherent with current CRC screening recommendations were lower for Hispanics (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59-0.86) and African Americans (OR 0.82, 95% CI 0.71-0.95) than for Whites. Residents of urban areas had higher odds (OR 1.19, 95% CI 1.06-1.34) of being up-to-date than rural residents. Among subjects who were not up-to-date with CRC screening, similar disparities were noted in receipt of physician recommendation for CRC screening. Conclusions: Certain groups are at increased risk of not receiving CRC screening or recommendations for screening from their physicians. Interventions to reduce these disparities should be an integral part of overall efforts to improve CRC prevention and control.