TY - JOUR
T1 - Racial and Ethnic Disparities in Cancer Screening
T2 - The Importance of Foreign Birth as a Barrier to Care
AU - Goel, Mita Sanghavi
AU - Wee, Christina C.
AU - McCarthy, Ellen P.
AU - Davis, Roger B.
AU - Ngo-Metzger, Quyen
AU - Phillips, Russell S.
N1 - Funding Information:
Dr.Goel is supported by an institutional National Research Service Award (5T32PE11001-13) and by the Ryoichi Sasakawa Fund. Dr.Wee is supported by a career development award from the National Institute of Diabetes, Digestive and Kidney Diseases (K23DK02962-02). Dr. McCarthy is the recipient of a First Independent Research and Transition Award from the National Cancer Institute (R29 CA79052).Dr.Ngo-Metzger is supported by the National Cancer Institute Asian American Network for Cancer Awareness, Research and Training (U01 CA86322). Dr. Phillips is supported by a Mid-Career Investigator Award from the National Institutes of Health (K24 AT00589-01A1).
PY - 2003/12
Y1 - 2003/12
N2 - CONTEXT: Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace. OBJECTIVE: To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening. DESIGN, SETTING, AND SUBJECTS: Cross-sectional study using 1998 data from the National Health Interview Survey. MAIN OUTCOME MEASURES: Completion of cervical, breast, or colorectal cancer screening. RESULTS: Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82). Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents. CONCLUSION: Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born.
AB - CONTEXT: Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace. OBJECTIVE: To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening. DESIGN, SETTING, AND SUBJECTS: Cross-sectional study using 1998 data from the National Health Interview Survey. MAIN OUTCOME MEASURES: Completion of cervical, breast, or colorectal cancer screening. RESULTS: Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82). Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents. CONCLUSION: Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born.
KW - Breast cancer
KW - Cancer screening
KW - Cervical cancer
KW - Colorectal cancer
KW - Health disparities
KW - Immigrant status
KW - Race/ethnicity
UR - http://www.scopus.com/inward/record.url?scp=0345863620&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0345863620&partnerID=8YFLogxK
U2 - 10.1111/j.1525-1497.2003.20807.x
DO - 10.1111/j.1525-1497.2003.20807.x
M3 - Article
C2 - 14687262
AN - SCOPUS:0345863620
SN - 0884-8734
VL - 18
SP - 1028
EP - 1035
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 12
ER -
