Mo1966 Colorectal Cancer Screening Among Asian Subgroups in a Large Managed Care Organization

Abstract

Background: Colorectal Cancer (CRC) is the second leading cause of cancer death in the US. 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 several modalities including an annual fecal immunochemical test (FIT) or fecal occult blood test (FOBT), a colonoscopy every 10 years, or a flexible sigmoidoscopy every 5 years for individuals ages 50-75. Although national rates in CRC screening have improved from 52.3% to 60%; screening rates among Asian Americans are 11% lower compared with whites. Differences among Asian subgroups is unknown. Methods: Electronic clinical data were used to characterize CRC screening status as of December 31, 2012 for Asians, overall and in subgroups, compared with non-Hispanic whites (NHWs) who were members of Kaiser Permanente Southern California. Asian subgroups were classified as Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian. To be eligible for these analyses, patients had to be ages 50-89 as of January 1, 2010 and enrolled in the health plan for a minimum of 3 years. The primary outcome, receipt of CRC screening, was defined as having a colonoscopy in the prior 10 years, sigmoidoscopy in the prior 5 years, or FIT/FOBT in the year before December 31, 2012. A secondary outcome was the distribution of screening modalities across Asian subgroups. Log-binomial regression analyses were used to estimate differences in screening patterns controlling for age and sex. Results: Among the 408,242 eligible patients, 11.6% were Asian (Table 1). Compared with NHWs, Asians had a higher proportion of females (53% v. 47%), were younger, and lived in neighborhoods with higher education. A higher percentage of Asians had received CRC screening than NHWs (76% v. 71%). Filipinos, who comprised nearly half of the Asian patients, had a similar percentage screened as NWHs, while Chinese, Korean, Vietnamese, and other Asians had slightly higher proportions screened (Table 1). Compared with NWHs, Asian Indians, Filipinos, Vietnamese, and other Asians were more often screened with FIT/FOBT; all subgroups except Filipino were more often screened with colonoscopy; and all subgroups except Asian Indians and Japanese patients were more often screened with flexible sigmoidoscopy (Table 2). Conclusions: In contrast to national data, in a large managed-care setting, Asians overall had higher CRC screening rates than NHWs. Compared to NHWs, the magnitude of differences in screening varied by Asian subgroup and type of screening modality. Table 1: Population breakdown by Race/Ethnicity