Jerant Anthony F, Fenton Joshua J, Franks Peter
Department of Family and Community Medicine, University of California Davis School of Medicine, 4860 Y St, Ste 2300, Sacramento, CA 95817, USA.
Arch Intern Med. 2008 Jun 23;168(12):1317-24. doi: 10.1001/archinte.168.12.1317.
The contributions of demographic, socioeconomic, access, language, and nativity factors to racial/ethnic colorectal cancer (CRC) screening disparities are uncertain.
Using linked data from 22 973 respondents to the 2001-2005 Medical Expenditure Panel Survey and the 2000-2004 National Health Interview Survey, we modeled disparities in CRC screening (fecal occult blood testing [FOBT], endoscopy, and combined FOBT and endoscopy) between non-Hispanic whites and Asians, blacks, and Hispanics, sequentially adjusting for demographics, socioeconomic status, clinical and access variables, and race/ethnicity-related variables (language spoken at home and nativity).
With demographic adjustment, minorities reported less CRC screening (all measures) than non-Hispanic whites. Disparities were largest for combined screening in Asians (adjusted odds ratio [AOR], 0.40; 95% confidence interval [CI], 0.32-0.49) and Hispanics (AOR, 0.43; 95% CI, 0.39-0.48) and for endoscopic screening in Asians (AOR, 0.41; 95% CI, 0.33-0.50) and Hispanics (AOR, 0.43; 95% CI, 0.38-0.48). With full adjustment, all Hispanic/non-Hispanic white disparities and black/non-Hispanic white FOBT disparities were eliminated, whereas Asian/non-Hispanic white disparities remained significant (FOBT: AOR, 0.72 [95% CI, 0.52-1.00]; endoscopic screening: AOR, 0.63 [95% CI, 0.49-0.81]; and combined screening: AOR, 0.66 [95% CI, 0.52-0.84]).
Determinants of racial/ethnic CRC screening disparities vary among minority groups, suggesting the need for different interventions to mitigate those disparities. Whereas socioeconomic, access, and language barriers seem to drive the CRC screening disparities experienced by blacks and Hispanics, additional factors may exacerbate the disparities experienced by Asians.
人口统计学、社会经济、就医机会、语言及出生地等因素对不同种族/族裔的结直肠癌（CRC）筛查差异的影响尚不确定。
利用2001 - 2005年医疗支出小组调查和2000 - 2004年国家健康访谈调查中22973名受访者的关联数据，我们对非西班牙裔白人、亚洲人、黑人和西班牙裔之间的CRC筛查差异（粪便潜血试验[FOBT]、内镜检查以及FOBT与内镜检查联合）进行建模，依次对人口统计学、社会经济地位、临床和就医机会变量以及与种族/族裔相关的变量（在家中使用的语言和出生地）进行调整。
经人口统计学调整后，少数族裔报告的CRC筛查（所有指标）少于非西班牙裔白人。亚洲人（调整后的优势比[AOR]，0.40；95%置信区间[CI]，0.32 - 0.49）和西班牙裔（AOR，0.43；95% CI，0.39 - 0.48）在联合筛查方面的差异最大，亚洲人（AOR，0.41；95% CI，0.33 - 0.50）和西班牙裔（AOR，0.43；95% CI，0.38 - 0.48）在内镜检查筛查方面的差异最大。经过全面调整后，所有西班牙裔/非西班牙裔白人之间的差异以及黑人和非西班牙裔白人在FOBT筛查方面的差异均被消除，而亚洲人与非西班牙裔白人之间的差异仍然显著（FOBT：AOR，0.72 [95% CI，0.52 - 1.00]；内镜检查筛查：AOR，0.63 [95% CI，0.49 - 0.81]；联合筛查：AOR，0.66 [95% CI，0.52 - 0.84]）。
不同少数族裔群体中种族/族裔CRC筛查差异的决定因素各不相同，这表明需要采取不同的干预措施来减轻这些差异。社会经济、就医机会和语言障碍似乎是导致黑人和西班牙裔CRC筛查差异的原因，而其他因素可能加剧了亚洲人所经历的差异。
