Summary
Adjustment for social determinants of health reduced racial and ethnic disparities in colorectal cancer screening among all minority racial and ethnic groups except non-Hispanic Asian individuals; however, other unmeasured confounders likely exist.
Original Article
Associations of Race, Ethnicity, and Social Determinants of Health With Colorectal Cancer Screening
Diseases of the Colon & Rectum
Kane, William J. M.D., M.S.; Fleming, Mark A. II M.D., M.S.; Lynch, Kevin T. M.D.; Friel, Charles M. M.D.; Williams, Michael D. M.D.; Hedrick, Traci L. M.D., M.S.; Yan, Guofen Ph.D.; Hoang, Sook C. M.D.
BACKGROUND:
Racial and ethnic disparities in receipt of recommended colorectal cancer screening exist; however, the impact of social determinants of health on such disparities has not been recently studied in a national cohort.
OBJECTIVE:
This study aimed to determine whether social determinants of health attenuate racial disparities in receipt of colorectal cancer screening.
DESIGN:
This was a cross-sectional telephone survey of self-reported race and ethnicity and up-to-date colorectal cancer screening. Associations between race/ethnicity and colorectal cancer screening were tested before and after adjustment for demographics, behavioral factors, and social determinants of health.
SETTING:
This was a nationally representative telephone survey of US residents in 2018.
PATIENTS:
The patients included were US residents aged 50 to 75 years.
MAIN OUTCOME MEASURES:
The primary outcome was up-to-date colorectal cancer screening status, according to 2008 US Preventive Services Task Force recommendations.
RESULTS:
This study included 226,106 respondents aged 50 to 75 years. Before adjustment, all minority racial and ethnic groups demonstrated a significantly lower odds of screening than those of non-Hispanic white respondents. After adjustment for demographics, behavioral factors, and social determinants of health, compared to non-Hispanic white respondents, odds of screening were found to be increased among non-Hispanic black respondents (OR, 1.10; p = 0.02); lower but attenuated among Hispanic respondents (OR, 0.73; p < 0.001), non-Hispanic American Indian/Alaskan Native respondents (OR, 0.85; p = 0.048), and non-Hispanic respondents of other races (OR, 0.82; p = 0.01); and lower but not attenuated among non-Hispanic Asian respondents (OR, 0.68; p < 0.001).
LIMITATIONS:
Recall bias, participant bias, and residual confounding.
CONCLUSIONS:
Adjustment for social determinants of health reduced racial and ethnic disparities in colorectal cancer screening among all minority racial and ethnic groups except non-Hispanic Asian individuals; however, other unmeasured confounders likely exist. See Video Abstract at https://links.lww.com/DCR/B977.
