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Article Title

Disparities in Colorectal Cancer Screening Rates Among Asian Subgroups in a Large Managed Care Organization

Publication Date

4-30-2015

Keywords

colorectal cancer screening, health care disparities

Abstract

Background/Aims: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. CRC screening allows for early detection of CRC or its precursors, and leads to a decrease in CRC incidence and mortality. National guidelines recommend screening with either an annual fecal immunochemical test (FIT), a colonoscopy every 10 years, or a flexible sigmoidoscopy every 5 years for individuals age 50–75 years. Nationally, the overall age-adjusted combined CRC screening rates increased from 52.3% to 65.4% between 2002 and 2010; however, screening rates among Asian Americans were 11% lower compared with whites, but differences among Asian subgroups is unknown. Thus, we examined CRC screening rates among Asian subgroups in a large managed care setting.

Methods: We used electronic data to characterize CRC screening among Asian subgroups (Japanese, Korean, Filipino, Asian-Indian, Chinese, Vietnamese, Other Asian) compared with white non-Hispanics (WNHs). Using descriptive and multivariable models, we evaluated 408,242 screening-eligible members of Kaiser Permanente Southern California aged 50–89 years as of January 1, 2010.

Results: Compared with WNHs over the past 3 years, Japanese were least likely and Koreans were most likely to have had any CRC screening exam (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.84–0.95; and OR 1.84, 95% CI 1.68–2.02, respectively). Of those screened, compared with WNHs, Japanese men were older (mean age 65.2 vs. 62.6). Screened Asian-Indians and Vietnamese had an equal distribution of men and women, while the other subgroups had more females. In the previous 3 years, Japanese were less likely to have had a FIT (41%, 1,742 of 4,301), and Vietnamese were more likely (56%, 2,248 of 4,018). In the previous 10 years, Koreans were more likely to have had a colonoscopy (56%, 1,797 of 3,189) and Filipinos were least likely (42%, 9,135 of 21,688).

Discussion: CRC screening rates and choice of screening test differ among Asian subgroups in an insured population. Further research is needed to understand the reasons for the differences among Asian subgroups, particularly the Japanese population.

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