Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis Sacramento, California 95817, USA.
Cancer. 2011 Apr 15;117(8):1755-63. doi: 10.1002/cncr.25668. Epub 2011 Jan 10.
The Medicare population has documented racial/ethnic disparities in colorectal cancer (CRC) screening, but it is unknown whether these disparities differ across geographic regions.
Among Medicare enrollees within 8 US states, we ascertained up-to-date CRC screening on December 31, 2003 (fecal occult blood testing in the prior year or sigmoidoscopy or colonoscopy in the prior 5 years). Logistic regression models tested for regional variation in up-to-date status among white versus different nonwhite populations (blacks, Asian/Pacific Islanders [APIs], Hispanics). We estimated regression-adjusted region-specific prevalence of up-to-date status by race/ethnicity and compared adjusted white versus nonwhite up-to-date prevalence across regions by using generalized least squares regression.
White versus nonwhite up-to-date status varied significantly across regions for blacks (P = .01) and APIs (P < .001) but not Hispanics (P = .62). Whereas the white versus black differences in proportion up-to-date were greatest in Atlanta (Georgia), rural Georgia, and the San Francisco Bay Area of California (range, 10%-16% differences, blacks<whites); there were no significant white versus black differences in Connecticut, Seattle (Washington) or Iowa. Whereas APIs had significantly lower up-to-date prevalence than whites in Michigan and the California regions of San Francisco, Los Angeles, and San Jose (range, 4%-15% differences, APIs<whites), APIs in Hawaii had higher up-to-date status than whites (52% vs 38% P < .001). White versus Hispanic differences were substantial but homogeneous across regions (range, 8%-16% differences, Hispanics<whites). In contrast to nonwhites, there was little geographic variation in up-to-date status among whites.
Significant geographic variation in up-to-date status among black and API Medicare enrollees is associated with heterogeneous racial/ethnic disparities for these groups across US regions.
医疗保险人群的结直肠癌（CRC）筛查存在种族/民族差异，但尚不清楚这些差异是否因地域不同而有所不同。
在 8 个美国州的医疗保险参保者中，我们确定了截至 2003 年 12 月 31 日的最新 CRC 筛查情况（前一年的粪便潜血检测或前 5 年的乙状结肠镜或结肠镜检查）。逻辑回归模型测试了白人与不同非白人人群（黑人、亚太裔[API]、西班牙裔）在最新状态方面的区域差异。我们根据种族/族裔估计了调整后的区域特定最新状态的流行率，并通过广义最小二乘回归比较了各区域调整后白人与非白人的最新流行率。
对于黑人（P =.01）和亚太裔（P <.001），白人与非白人的最新状态在各区域之间存在显著差异，但对于西班牙裔（P =.62）则不然。在亚特兰大（佐治亚州）、乔治亚州农村地区和加利福尼亚州旧金山湾区，白人与黑人之间在最新状态比例上的差异最大（范围为 10%-16%，黑人<白人）；在康涅狄格州、西雅图（华盛顿州）或爱荷华州，不存在显著的白人与黑人之间的差异。在密歇根州和旧金山、洛杉矶和圣何塞的加利福尼亚地区，亚太裔的最新筛查率明显低于白人（范围为 4%-15%，亚太裔<白人），而在夏威夷州，亚太裔的最新筛查率则高于白人（52%对 38%，P <.001）。白人与西班牙裔之间的差异很大，但在各区域内是同质的（范围为 8%-16%，西班牙裔<白人）。与非白人不同，白人的最新状态在各区域之间几乎没有地理差异。
医疗保险参保的黑人和亚太裔在最新状态方面存在显著的地域差异，这与美国各地区这些群体的种族/民族差异有关。
