Health Disparities in Colorectal Cancer Screening in The United States: Race/ethnicity or Shifting Paradigms?

Background: Colorectal cancer (CRC) remains the third leading cause of cancer death in the United States. The incidence, mortality, and screening vary by race/ethnicity, with African Americans and Hispanics being disproportionately represented. Early detection through screening prolongs survival and decreases mortality. CRC screening (CRCS) varies by race/ethnicity, with lower prevalence rates observed among minorities, but the factors associated with such disparities remain to be fully understood. The current study aimed to examine the ethnic/racial disparities in the prevalence of CRCS, and the explanatory factors therein in a large sample of U.S. residents, using the National Health Interview Survey, 2003. Materials and Methods: A cross-sectional, epidemiologic design was used with a chi square to assess the prevalence of CRCS, while a survey logistic regression model was used to assess the odds of being screened. Results: There was a significant variability in CRCS, with minorities demonstrating lower prevalence relative to Caucasians χ2 (3) = 264.4, p< 0.0001. After controlling for the covariates, racial/ethnic disparities in CRCS persisted. Compared to Caucasians, African Americans/Blacks were 28% (adjusted prevalence odds ratio [APOR] = 0.72, 99% CI, 0.600.80), while Hispanics were 33% (APOR, 0.67, 99% CI, 0.53-0.84) and Asians were 37% (APOR, 0.63, 99% CI, 0.43-0.95) less likely to be screened for CRC. Conclusion: Among older Americans, racial/ethnic disparities in CRCS exist, which was unexplained by racial/ethnic variance in the covariates associated with CRCS. These findings recommend further studies in enhancing the understanding of confounders and mediators of disparities in CRCS and the application of these factors including the health belief model in improving CRCS among ethnic/racial minorities.