Impact of patient-provider race/ethnicity and gender concordance on cancer screening: Findings from medical expenditure panel survey.

Abstract

1547 Background: Racial/ethnic minority groups experience lower rates of cancer screening compared to non-Hispanic (NH) whites. Previous studies evaluating the role of patient-provider race/ethnicity and gender concordance in cancer screening have been inconclusive. Methods: We conducted a cross-sectional study of 18,690 patient-provider pairs using the 2003-2010 Medical Expenditure Panel Survey (MEPS) data. We assessed association between patient-provider race/ethnicity and gender concordance and, screening adherence for breast, cervical, and colorectal cancer using American Cancer Society guidelines. Separate multivariable logistic regression adjusting for demographics, self-reported health and MEPS survey year were conducted to examine relationships of interest. Results: Seventy percent of patients were NH-white, 15% were NH-black and 15% were Hispanic. Patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Among NH-black and NH-whites, patient-provider racial/ethnic concordance was not associated with screening adherence. Among Hispanics, patient-provider racial/ethnic discordant pairs had higher colorectal cancer screening rates as compared to concordant pairs (OR 1.48; 95% CI 1.28-1.71). This association was significant even on adjusting for gender concordance and survey language (English vs. Spanish). Conversely, patient-provider gender discordance was associated with lower rates of breast (OR 0.81; 95% CI 0.74-0.89), cervical (OR 0.79; 95% CI 0.72-0.87) and colorectal cancer (OR 0.86; 95% CI 0.80-0.93) screening adherence in all patients. This association was also significant on restricting analysis to racial/ethnic concordant pairs. Conclusions: Patient-provider gender concordance positively impacts adherence to cancer screening and this finding may guide future interventions. Patient-provider racial/ethnic concordance is not associated with screening adherence among whites and blacks but Hispanic patients seen by Hispanic providers have lower colorectal cancer screening rates. This counter-intuitive finding requires further study.