Burgess DJ (Center for Chronic Disease Outcomes Research and University of Minnesota), van Ryn M
(University of Minnesota), Grill J
(Center for Chronic Disease Outcomes Research), Noorbaloochi S
(Center for Chronic Disease Outcomes Research and University of Minnesota), Griffin JM
(Center for Chronic Disease Outcomes Research and University of Minnesota), Vernon S
(University of Texas-Houston School of Public Health), Fisher D
(Durham Veterans Affairs Medical Center and Duke University Medical Center), Partin MR
(Center for Chronic Disease Outcomes Research and University of Minnesota)
We examined the presence and correlates of black/white racial disparities in adherence to guidelines for colorectal cancer screening (CRC) among VA patients.
The study sample included 339 African American and 1,749 white veterans responding to a national survey of patients, age 50-75, who received care from the Veterans Health Administration (VHA) and who had no history of bowel disease (response rate 83%). Veterans were surveyed by mail, with a telephone follow-up. Gender, age, and comorbidities were obtained through VA medical records. Other demographic factors, cognitive factors, and environmental factors were obtained through the survey. Use of CRC screening and race were derived by supplementing survey responses with administrative data when survey data were missing. We used hierarchical logistic regression analysis to assess how demographic, cognitive, and environmental characteristics contributed to racial disparities in CRC screening adherence.
Unadjusted analyses revealed lower rates of adherence to CRC screening recommendations among African American than white veterans (76% versus 82%; OR 0.70, p = .0003). However, these disparities became nonsignificant after controlling for demographic characteristics (OR 0.83, p = .25), primarily because African American respondents were younger, in poorer health, and more likely to have a diagnosis of substance abuse, all of which were associated with lower adherence to CRC screening recommendations in bivariate analyses. Controlling for cognitive factors increased rather than decreased the African American disadvantage (OR 0.76, p = .08) relative to the model controlling only for other demographic factors (OR 0.83, p = .25), primarily because African Americans reported higher motivation to be screened than whites. Cognitive factors (lower levels of CRC screening knowledge) and medical care factors (lower likelihood of using non-VA care) also contributed to lower rates of CRC screening among African Americans.
African American veterans were less likely to be adherent to CRC screening guidelines than white veterans due to demographic, cognitive, and medical care factors, despite greater motivation to be screened.
Relatively greater readiness of African Americans to engage in CRC screening, compared with whites, suggests an opportunity for future interventions to improve screening within this population.