Table 1.
Evidence for Racial Differences in CRC Screening Utilization
| Unadjusted Percentage With the Screening Behavior | Odds Ratios and Risk Ratios* Black Relative to White With 95% Confidence Intervals |
||||||||
|---|---|---|---|---|---|---|---|---|---|
| Black |
White |
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| Outcome/data source | Data Type | Data Collection Years | Age Range (Years) | % | N | % | N | Unadjusted | Adjusted** |
| Up-to-date with CRC Screening Guidelines | |||||||||
| Based on receipt of FOBT | |||||||||
| NHIS (Anderson, 1995)39† | Survey | 1987 | >=50 | 15.8 | — | 22.4 | — | — | — |
| NHIS (Anderson, 1995)39† | Survey | 1992 | >=50 | 22.4 | — | 26.6 | — | — | — |
| MCBS (Doubeni, 2009)40 | Survey | 2000 | 65–80 | — | 761 | — | 6,705 | 0.56 (0.42,0.74) | 0.84 (0.62,1.13) |
| MCBS (Doubeni, 2009)40 | Survey | 2005 | 65–80 | — | 636 | — | 6,023 | 0.67 (0.45,1.01) | 0.80 (0.54,1.20) |
| Based on receipt of endoscopy | |||||||||
| MCBS (Doubeni, 2009)40 | Survey | 2000 | 65–80 | — | 761 | — | 6,705 | 0.70 (0.57,0.86) | 1.06 (0.88,1.30) |
| MCBS (Doubeni, 2009)40 | Survey | 2005 | 65–80 | — | 636 | — | 6,023 | 0.74 (0.57,0.96) | 1.11 (0.86,1.45) |
| Based on receipt of FOBT/FIT or endoscopy | |||||||||
| MEPS (Jerant, 2008)41 | Survey | 2001–2005 | >=50 | 48.2 | 2,809 | 57.2 | 14,823 | — | 0.86 (0.77,0.95) |
| VHA (Burgess, 2010)42 | Survey, EHR | 2005–2006 | 50–75 | 72 | 328 | 77 | 1,827 | 0.74 — | 0.91 — |
| BRFSS (Liss, 2014)43 | Survey | 2010 | 50–75 | 59.0 | — | 62.0 | — | 0.96 (0.94,0.98) | 1.02 (1.00,1.04) |
| NHIS (Sauer, 2018)44 | Survey | 2010–2013 | 50–75 | 56.8 | 3,567 | 59.8 | 14,527 | — | — |
| BRFSS (Sauer, 2018)44 | Survey | 2012–2014 | 50–75 | 67.5 | 34,191 | 67.1 | 362,721 | — | — |
| Health Center Patient Survey (Lee, 2020)45 | Survey | 2014 | >=50 | 61.3 | — | 58.6 | — | 1.07 — | 1.28 (1.02,1.60) |
| BRFSS (May, 2019)46 | Survey | 2008 | 50–75 | 60.6 | 13,830 | 63.9 | 157,150 | — | — |
| BRFSS (May, 2019) | Survey | 2010 | 50–75 | 64.4 | 16,871 | 66.2 | 180,961 | — | — |
| BRFSS (May, 2019) | Survey | 2012 | 50–75 | 65.8 | 17,978 | 67.4 | 180,654 | — | — |
| BRFSS (May, 2019) | Survey | 2014 | 50–75 | 67.8 | 15,943 | 68.4 | 180,150 | — | — |
| BRFSS (May, 2019) | Survey | 2016 | 50–75 | 66.4 | 17,518 | 70.4 | 186,331 | — | — |
| Receipt of CRC Screening | |||||||||
| Screening colonoscopy | |||||||||
| National Colonoscopy Study (Mendelsohn, 2017)32† | RCT | 2000–2002 2004–2007 |
40–69 | 77.9 | 245 | 82.9 | 240 | 0.94 (0.86,1.02) | 1.03 (0.96,1.11) |
| FOBT or endoscopy | |||||||||
| TRICARE (Changoor, 2018)48† | Claims | 2010–2013 | 50–53 | 56.5 | 5,062 | 53.5 | 17,258 | 1.14 (1.06,1.23) | 1.20 (1.11,1.29) |
| FIT | |||||||||
| ADVANCE (Huguet, 2019)49 | EHR | 2012–2013 | 50–64 | 10.5 | 32,101 | 9.2 | 76,344 | — | — |
| ADVANCE (Huguet, 2019)49 | EHR | 2014–2015 | 50–64 | 17.9 | 32,936 | 15.4 | 81,006 | — | — |
| Complete Screening Episode | |||||||||
| PROSPR (Burnett-Hartman, 2016)50 | EHR | 2010–2012 | 50–75 | 50.9 | 157,999 | 56.2 | 938,295 | — | 0.89 (0.88,0.91) |
| Follow-up Colonoscopy after Referral | |||||||||
| PLCO, 1st screening (Laiyemo, 2010)31 | RCT | 1993–2001 | 55–74 | 62.6 | 767 | 72.4 | 13,743 | — | 0.88 (0.83, 0.93) |
| PLCO, 2nd screening (Laiyemo, 2015)51 | RCT | 2009–2011 | 58–79 | 76.6 | 304 | 83.1 | 4,183 | — | 0.90 (0.84, 0.96) |
| VHA (Partin, 2017)52 | EHR | 2009–2011 | 50–85 | 55 | 13,618 | 48 | 49,692 | 1.33 (1.28,1.39) | 1.19 (1.14,1.25) |
| PROSPR (Burnett-Hartman, 2016)50 | EHR | 2010–2012 | 50–75 | 51.9 | 9,954 | 56.2 | 56,298 | — | 0.94 (0.88,1.00) |
| Repeat Screening | |||||||||
| PLCO, 2nd screening (Laiyemo, 2015)51 | RCT | 2009–2011 | 58–79 | 60.6 | 1609 | 69.2 | 31,117 | — | — |
| PROSPR, surveillance colonoscopy (Chubak, 2020)53 | EHR | 2010–2014 | 50–89 | 50.3 | — | 47.4 | — | — | 1.17 (0.99,1.39) |
Abbreviations: ADVANCE: Accelerating Data Value Across a National Community health center network; BRFSS: Behavioral Risk Factors Surveillance System; EHR: Electronic Health Record; FOBT: fecal occult blood test; FIT: fecal immunochemical test; NHIS: National Health Interview Survey; MCBS: Medicare Current Beneficiary Survey; PLCO: Prostate, Lung, Colorectal and Ovarian; PROSPR: Population-based Research to Optimize the Screening Process; RCT: Randomized Controlled Trial; SEER: VHA: Veterans Health Affairs.
Risk ratios are provided in italics to distinguish them from odds ratios.
Characteristics adjusted for in aOR and aRR estimates: MCBS40: age, sex, education, income, insurance type, usual place of health care, marital status, body mass index (BMI), census division, residence in a metropolitan service area, delayed care due to cost, language of the interview, self-reported general health status, and history of non–skin cancer; MEPS41: age, sex, education, and income; VHA (Burgess)42: age, education, income, family history of CRC, overall health, comorbidities, substance or psychiatric diagnoses; BRFSS (Liss)43: age, sex, education, income, insurance coverage, usual source of care, checkup in past year; National Colonoscopy Study31: age, sex, and education; TRICARE48: sex, marital status, beneficiary category (retired, dependent, active duty, other), self or sponsor rank (enlisted, officer, other), type of care facility (military or civilian), self or sponsor service (Air Force, Army, Navy, Coast Guard, Marine, other), region (South, Midwest, Northeast, West); PROSPR (Burnette-Hartman)50: age, sex, income, insurance type, length of prior enrollment, type of residence, comorbidity, and study site; PLCO, first screening31: age, sex, education, BMI, smoking status, family history of CRC, history of CRC within 3 years of enrollment, history of colon polyps, and screening center; PLCO, second screening51: age, sex, education, BMI, smoking status, family history of CRC, year of repeat flexible sigmoidoscopy and screening center; VA (Partin)52: age, comorbidity, prior colonoscopy, personal history of polyps, ordering physician, ordering facility. PROSPR (Chubak)53: age, sex, index colonoscopy findings, health system, insurance type, comorbidity index;
People of Hispanic ethnicity were included in both black and white groups.