Racial Differences in Colorectal Cancer Test Use by Medicare Consumers

Abstract

Lower use of colorectal cancer (CRC) screening has been suggested as a factor in higher rates of CRC incidence and mortality among African Americans. Racial differences in colorectal cancer test use are not well understood. The study sample included respondents aged 50 to 80 to a 2001 telephone survey of Medicare consumers from two states. The analyses, initiated in 2004, were limited to respondents with no history of CRC (n = 1901). Three CRC tests were examined: fecal occult blood tests (FOBTs), sigmoidoscopy, and colonoscopy. Type of testing and testing according to Medicare coverage intervals by race were compared. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from unadjusted and adjusted models to assess the independent associations between race and test use. Adherence to the Medicare-covered intervals for CRC tests was low (56.8% for whites, 39.1% for African Americans), and did not significantly differ by race after adjustment. African Americans were, however, significantly less likely to have ever been tested (OR = 0.48, 95% CI = 0.33-0.70) and more likely to have had an endoscopic test than an FOBT (OR = 3.06, 95% CI = 1.70-5.51). The type of test used to screen for colorectal cancer has important implications for compliance with recommended screening intervals. Understanding reasons for racial differences in CRC test use may help identify approaches to increasing test use in the Medicare population.