Cooper Gregory S, Koroukian Siran M
Division of Gastroenterology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-5066, USA.
Cancer. 2004 Jan 15;100(2):418-24. doi: 10.1002/cncr.20014.
African Americans are diagnosed more frequently with colorectal carcinoma at a later stage compared with Caucasians. One potential reason for the disparity is a lower rate of screening examinations.
Using Outpatient and Physician-Supplier claims for all Medicare beneficiaries age > or = 65 years in 1999, indications for fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, and barium enema were divided into diagnostic, surveillance, or screening categories. Annualized rates were calculated based on the number of eligible fee-for-service months.
Rates of FOBT (18.24% vs. 11.86%; P < 0.001) and sigmoidoscopy (3.07% vs. 2.17%; P < 0.001) were higher in Caucasians compared with African Americans, whereas rates of barium enema were higher in African Americans (2.26% vs. 1.88%; P < 0.001). Colonoscopy use was more frequent among men only in Caucasians compared with African-Americans (8.00% vs. 6.97%; P < 0.001). For FOBT, sigmoidoscopy, and colonoscopy, the racial differences in procedures performed for diagnostic purposes were of smaller magnitude than for screening; and, for colonoscopy, the use of diagnostic procedures actually was higher for African Americans.
Racial disparities exist not only in the use of colorectal procedures but also in the indications for such testing, with African Americans less likely to undergo screening tests. The differences are consistent with delay in diagnosis until symptoms or signs develop and may contribute to disparities in cancer mortality.
与白种人相比，非裔美国人被诊断为结直肠癌时的分期更晚。造成这种差异的一个潜在原因是筛查检查率较低。
利用1999年所有年龄≥65岁的医疗保险受益人的门诊和医生供应商索赔数据，将粪便潜血试验（FOBT）、乙状结肠镜检查、结肠镜检查和钡灌肠的指征分为诊断、监测或筛查类别。根据符合条件的按服务收费月份数计算年化率。
与非裔美国人相比，白种人的FOBT（18.24%对11.86%；P<0.001）和乙状结肠镜检查率（3.07%对2.17%；P<0.001）更高，而非裔美国人的钡灌肠率更高（2.26%对1.88%；P<0.001）。与非裔美国人相比，仅在白种人中男性使用结肠镜检查更为频繁（8.00%对6.97%；P<0.001）。对于FOBT、乙状结肠镜检查和结肠镜检查，出于诊断目的进行的检查的种族差异小于筛查；而且，对于结肠镜检查，非裔美国人实际使用诊断性检查的比例更高。
不仅在结直肠检查的使用方面存在种族差异，而且在这类检查的指征方面也存在差异，非裔美国人接受筛查检查的可能性较小。这些差异与直到出现症状或体征才进行诊断的延迟情况一致，可能导致癌症死亡率的差异。
