Mo1068 Colorectal Cancer Disparities Between Blacks and Hispanics: Healthcare Utilization Versus Biological Differences

Abstract

Background: Despite comparable rates of putative risk factors for colorectal cancer including poor access and lower screening uptake, Hispanic Americans have reduced burden of colorectal cancer when compared to Blacks. It is unknown if better healthcare utilization (when access is available) or biological differences are playing a major role in this disparity within minority groups. Aim: To compare the adherence to scheduled out-patient colonoscopy (healthcare utilization) and the findings of neoplasia (biological differences) during colonoscopy performed among compliant patients by race-ethnicity (Blacks versus Hispanics). Method: A total of 2,126 (88.2%) non-Hispanic Black and 284 Hispanic (11.8%) adult patients were scheduled for out-patient colonoscopy from September 2009 to August 2010 in our endoscopy suite at Howard University Hospital, a minority serving tertiary institution in Washington DC. We reviewed their records and abstracted the data in standard fashion. We compared Blacks to Hispanics in their rates of attendance to the scheduled colonoscopy, the quality of colonoscopy performed and the detection of neoplasia. We used logistic regression models to calculate odds ratio (OR) and 95% confidence interval (CI) and adjusted for age, sex, marital status and health insurance. Results: Blacks were slightly older (mean age 56.5 years versus 52.7 years, P<0.001) and were less likely to be married (23% versus 32%, P = 0.001), but there was no difference by sex (P = 0.64). A lower percentage of Blacks were compliant with their procedures (76.9% versus 82%, OR = 0.76; 95%CI: 0.541.06). There was no difference in cecal intubation rate (97.5% versus 97.4%, P = 0.93) and finding of good bowel preparation (73% versus 71.5%, P = 0.13). Blacks were more likely to have polyps (50.8% versus 33.2%, OR = 2.10; 95%CI: 1.54-2.88) and adenoma (26.3% versus 18.8%, OR = 1.53; 95%CI: 1.05-2.23). These differences were mainly from diagnostic procedures (Table). Nine (0.57%) Blacks and one (0.44%) Hispanic had colorectal cancer diagnosed (P = 0.8). Conclusion: Although Blacks were borderline less likely to attend their scheduled colonoscopy, they were significantly more likely to have colorectal neoplasia. This suggests that biological differences may be playing more of a role in the increased burden of CRC among Blacks as compared to Hispanics. Comparison of prevalence of adenoma among blacks and Hispanics by indication of colonoscopy