Factors explaining racial/ethnic disparities in rates of physician recommendation for colorectal cancer screening

Am J Public Health. 2013 Jul;103(7):e91-9. doi: 10.2105/AJPH.2012.301034. Epub 2013 May 16.


Objectives: Physician recommendation plays a crucial role in receiving endoscopic screening for colorectal cancer (CRC). This study explored factors associated with racial/ethnic differences in rates of screening recommendation.

Methods: Data on 5900 adults eligible for endoscopic screening were obtained from the National Health Interview Survey. Odds ratios of receiving an endoscopy recommendation were calculated for selected variables. Planned, sequenced logistic regressions were conducted to examine the extent to which socioeconomic and health care variables account for racial/ethnic disparities in recommendation rates.

Results: Differential rates were observed for CRC screening and screening recommendations among racial/ethnic groups. Compared with Whites, Hispanics were 34% less likely (P < .01) and Blacks were 26% less likely (P < .05) to receive this recommendation. The main predictors that emerged in sequenced analysis were education for Hispanics and Blacks and income for Blacks. After accounting for the effects of usual source of care, insurance coverage, and education, the disparity reduced and became statistically insignificant.

Conclusions: Socioeconomic status and access to health care may explain major racial/ethnic disparities in CRC screening recommendation rates.

MeSH terms

  • Aged
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / ethnology
  • Cross-Sectional Studies
  • Early Detection of Cancer / statistics & numerical data*
  • Ethnicity / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Health Services Accessibility / statistics & numerical data
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Physicians
  • Racial Groups / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data
  • Social Class
  • United States