Racial Minorities Are More Likely Than Whites to Report Lack of Provider Recommendation for Colon Cancer Screening
Racial Minorities Are More Likely Than Whites to Report Lack of Provider Recommendation for Colon Cancer Screening
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DOI：
10.1038/ajg.2015.138
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发表时间：
2015-10-01
影响因子：
9.8
通讯作者：
Spiegel, Brennan M. R.
中科院分区：
文献类型：
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作者：
May, Folasade P.;Almario, Christopher V.;Spiegel, Brennan M. R.
目的：尽管美国推荐对所有50岁至75岁的成年人进行结直肠癌(CRC)筛查，但在接受筛查的人中存在种族和民族差异。缺乏适当的结直肠癌筛查的人列举了不遵守的各种原因，包括缺乏筛查提供者的建议。这项研究的目的是评估患者种族和缺乏结直肠癌筛查提供者建议之间的关联，作为筛查未坚持的主要原因。方法：我们对2009年加州健康访谈调查中50至75岁的个人进行了横断面观察性研究，这些人报告没有遵守2008年美国预防服务工作组的结直肠癌筛查指南。结果是自我报告说，没有接受结直肠癌筛查的主要原因是缺乏筛查的医生推荐(“非推荐”)。我们用Logistic回归来确定不推荐的显著预测因素，并特别注意种族的作用。结果：研究队列包括5793名未经筛选的受试者。在受试者中，19.1%的人报告说缺乏提供者推荐是结直肠癌不进行筛查的主要原因。非洲裔美国人(调整后的赔率比(AdJ.或)1.46，95%可信区间(CI)1.03-2.05)和说英语的亚洲人(adj.或1.65，95%CI 1.24-2.20)比白人更有可能报告医生不推荐为缺乏筛查的主要原因。然而，说非英语的亚洲人不太可能报告医生不推荐(adj.或0.31，95%CI 0.11-0.91)。结论：少数民族比白人更不可能获得医生推荐的结直肠癌筛查。未来的研究应该评估为什么种族似乎会影响提供者进行结直肠癌筛查的建议；这是减少结直肠癌筛查差距和减轻美国结直肠癌负担的重要一步。
OBJECTIVES: Although screening for colorectal cancer (CRC) is recommended for all adults aged 50 to 75 years in the United States, there are racial and ethnic disparities in who receives screening. Individuals lacking appropriate CRC screening cite various reasons for nonadherence, including lack of provider recommendation for screening. The purpose of this study is to evaluate the association between patient race and lack of provider recommendation for CRC screening as the primary reason for screening nonadherence.METHODS: We conducted a cross-sectional observational study of individuals aged 50 to 75 years from the 2009 California Health Interview Survey who reported nonadherence to 2008 United States Preventive Service Task Force CRC screening guidelines. The outcome was self-report that the main reason for not undergoing CRC screening was lack of a physician recommendation ("non-recommendation") for screening. We performed logistic regression to determine significant predictors of non-recommendation, with particular attention to the role of race.RESULTS: The study cohort included 5,793 unscreened subjects. Of the subjects, 19.1% reported that lack of a provider recommendation was the main reason for CRC nonscreening. African Americans (adjusted odds ratio (adj. OR) 1.46, 95% confidence interval (CI) 1.03-2.05) and English-speaking Asians (adj. OR 1.65, 95% CI 1.24-2.20) were more likely than whites to report physician non-recommendation as the main reason for lack of screening. Asian non-English speakers, however, were less likely to report physician non-recommendation (adj. OR 0.31, 95% CI 0.11-0.91).CONCLUSION: Racial minorities are less likely than whites to receive a physician recommendation for CRC screening. Future research should evaluate why race appears to influence provider recommendations to pursue CRC screening; this is an important step to reduce disparities in CRC screening and lessen the burden of CRC in the United States.