Understanding the factors underlying disparities in cancer screening rates using the Peters-Belson approach: results from the 1998 National Health Interview Survey

Med Care. 2004 Aug;42(8):789-800. doi: 10.1097/01.mlr.0000132838.29236.7e.


Background: Cancer screening rates vary substantially by race and ethnicity. We applied the Peters-Belson approach, often used in wage discrimination studies, to analyze disparities in cancer screening rates between different groups using the 1998 National Health Interview Survey.

Methods: A regression model predicting the probability of getting screened is fit to the majority group and then used to estimate the expected values for minority group members had they been members of the majority group. The average difference between the observed and expected values for a minority group is the part of the disparity that is not explained by the covariates.

Results: The observed disparities in colorectal cancer screening (5.88%) and digital rectal screening (8.54%) between white and black men were explained fully by the difference in their covariate distributions. Only half of the disparity in the observed screening rates (13.54% for colorectal and 17.47% for digital rectal) between white and Hispanic men was explained by the difference in covariates between the groups. The entire disparity observed in mammography screening rates for black and Hispanic women (2.71% and 6.53%, respectively) compared with white women was explained by the difference in covariate distributions.

Conclusions: We found that the covariates that explain the disparity in screening rates between the white and the black population do not explain the disparity between the white and the Hispanic population. Knowing how much of a health disparity is explained by measured covariates can be used to develop more effective interventions and policies to eliminate disparity.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • African Continental Ancestry Group / psychology
  • African Continental Ancestry Group / statistics & numerical data*
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / ethnology
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / ethnology
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Endoscopy, Gastrointestinal / statistics & numerical data
  • European Continental Ancestry Group / psychology
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Health Services Accessibility / statistics & numerical data*
  • Hispanic Americans / psychology
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Male
  • Mammography / statistics & numerical data
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • National Center for Health Statistics, U.S.
  • Patient Acceptance of Health Care / ethnology*
  • Poverty / ethnology
  • Prejudice
  • Probability
  • Regression Analysis
  • Socioeconomic Factors
  • United States