Study Shows No Racial Disparities in Adherence to CRC Screening among Veterans Receiving VA Care
Compared with Whites, African Americans are more likely to present with Stage IV colorectal cancer (CRC) and are less likely to survive. These disparities are partly attributable to lower rates of CRC screening among African Americans. This study examined the contribution of demographic/health-related factors, cognitive factors, and environmental factors to racial disparities in CRC screening in a nationally representative survey of Veterans ages 50 to 75. Investigators analyzed data for 328 African American Veterans and 1,827 White Veterans who received primary care at one of 24 VA medical facilities between 1/05 and 12/06, and who had completed a 2003 organizational survey on CRC screening. At the time of the survey, CRC screening guidelines recommended men and women age 50 and older have either a fecal occult blood test (FOBT) annually, sigmoidoscopy or double contrast barium enema (DCBE) every five years, colonoscopy every 10 years, or a combination of annual FOBT and sigmoidoscopy every five years. Participants were considered adherent if either their self-report survey or VA claims data indicated that they had followed these guidelines. Investigators also examined patient race, demographics and health factors (e.g., comorbidities), cognitive factors (e.g., CRC knowledge), and environmental factors (e.g., social and medical).
- The effect of race on adherence to CRC screening guidelines was non-significant after adjusting for demographic/health-related factors and environmental factors.
- Adherence in both African American and White groups was substantially higher than the national average. The high rates of CRC screening are likely, in part, a result of various VA efforts initiated over the past decade to increase screening adherence.
- There were no racial differences in physician recommendations for CRC screening: 84% for African Americans and 85% for Whites.
- Among those who were adherent to CRC screening, African American Veterans had significantly lower rates of colonoscopy compared with White Veterans (47% vs. 57%) and significantly higher rates of FOBT (60% vs. 53%).
- Part of these findings is based on self-report, and some over-reporting of adherence might have occurred.
This study was funded by HSR&D (IIR 04-042) and by Career Development Awards to Drs. Burgess and Fisher. Dr. Burgess, as well as most of the authors, is part of HSR&D’s Center for Chronic Disease Outcomes Research in Minneapolis, MN.
Burgess D, van Ryn M, Grill J, et al. Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines. Journal of General Internal Medicine 2011 Mar;26(3):251-58.