Colorectal cancer prevention: Adherence patterns and correlates of tests done for screening purposes within U.S. populations

Abstract

Predictors of adherence to one or more CRC screening guidelines in the United States need to be viewed from the most stringent perspective possible, and previous reports have not adequately explored them. Multiple logistic regression was used on the National Health Interview Survey (2000). Our sample consisted of the U.S. population 50 years of age and older using an outcome variable representing adherence to any combination of endoscopic test or home fecal occult blood test done for screening purposes only and within recommended timelines. Only 25.8% (24.9%, 26.7%; 95% CI) of the eligible population was adherent for CRC screening. Hispanics had the lowest adherence rates irrespective of test time, reason or type. Whites were more likely than Blacks and Hispanics for ‘ever had a CRC test'; Blacks were equally likely to Hispanics. Whites were more likely than Blacks and Hispanics to be “time-only adherent;” Blacks were more likely than Hispanics. Blacks were more likely than Whites to have had an endoscopy for screening reasons but no other significant racial differences for screening-test categories existed. In the multivariate model, differences between Whites and Blacks in time-and-screening adherence rates disappeared; Hispanics remained less likely. Among Whites, increasing education predicted increasing adherence, but only the educational category of undergraduate college completion, as compared to a less than high school level education, predicted increasing adherence among Blacks. Male gender predicted greater adherence only among Blacks. Insurance predicted greater adherence only among Hispanics. National rates of timely CRC tests for screening purposes are lower than recent studies report. Factors influencing adherence rates differ within races and screening promotion efforts should be tailored accordingly.