Understanding Reversed Race/Ethnic Associations with Cancer Screening Tests

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DESCRIPTION (provided by applicant): Evidence for disparities in the utilization of screening tests plays a central role in the nation's efforts at cancer prevention and control. Persons in traditionally underserved racial and ethnic groups have had lower screening rates relative to non-Hispanic Whites. In addition, they often have disproportionately higher morbidity and mortality. The process of making decisions about groups in the population who are "at-risk" of lower screening test utilization typically starts with bivariate analyses of the associations between a set of potential covariates and use of a screening test. The next step is to conduct multivariable analysis most often using logistic regression, to identify the final set of variables that achieve statistical significance. This final set of statistically significant variables is then translated into population groups who need targeted interventions to reduce disparities. This proposed research addresses a situation we, and others, have observed in several analyses of cancer screening in population-based data sets. That is, analyses done with different survey databases have found several instances where bivariate associations between race/ethnicity and cancer screening have been "reversed" in multivariable analyses. That is, a group with lower screening in bivariate ("crude rate") analysis shows higher screening based on the "adjusted" results from the multivariable analysis. These reversals may have implications not only for intervention planning, but also for the way that analyses are conducted to identify correlates of a screening procedure. The Specific Aims of this proposed research are: 1.) To investigate the extent of reversals of associations from bivariate to multivariable analyses of the correlates of cancer screening, by examining results several population-level surveys, by using multiple years of each survey, and by expanding the scope of screening tests to include both women and men. 2.) To investigate variables that may explain reversals of association when comparing the results of bivariate and multivariate analyses of factors associated with cancer screening tests. This two-year project will conduct secondary analyses with multiple years of data from three national- level surveys: The National Health Interview Survey, The Behavioral Risk Factor Surveillance System, and the Health Information National Trends Survey. Five screening tests will be examined: mammography, clinical breast exam, Pap testing, prostate exam, and colorectal examination. This research will extend research to date in several ways. First, it greatly expands the number of survey databases being examined. Second, it expands the number of screening tests being reviewed, and gives added attention to male screening. Third, it uses definitions of screening that are as consistent as possible across the individual surveys. Fourth, it uses a consistent set of independent variables across the surveys. Fifth, it will be possible to look for trends over time in the presence of reversals of association for repeat screening.