Understanding racial and ethnic disparities in colorectal cancer screening: Behavioral Risk Factor Surveillance System, 2002 and 2004.

INTRODUCTION Racial/ethnic disparities in colorectal cancer (CRC) screening exist. The literature suggests that differential treatment by race may influence health behaviors and health outcomes. OBJECTIVE We examined the impact of Reactions to Race-based treatment on being up-to-date with colorectal cancer screening with endoscopy or fecal occult blood testing (FOBT) among non-Hispanic White, non-Hispanic Black, and Hispanic men and women aged > or = 50 years. DESIGN Secondary data analysis of the Reactions to Race Module on the 2002 and 2004 Behavioral Risk Factor Surveillance System (BRFSS) was performed. Using logistic regression, we examined the strength of association between Reactions to Race-based treatment variables with up-to-date CRC screening tests after adjusting for demographic and access variables. MAIN OUTCOME MEASURES CRC screening tests were analyzed independently as FOBT within 2 years (n = 30,134) and endoscopy (colonoscopy or sigmoidoscopy) within 5 years (n = 30,210). RESULTS Among Whites, 34% reported FOBT, compared with 30.6% of Blacks and 15.3% of Hispanics (P < .05). Forty-five percent of Whites reported endoscopy, compared with 40.7% of Blacks and 32.1% of Hispanics (P < .05). After adjusting for sociodemographic characteristics, Hispanics who always thought about their race were 73% (OR = .27; 95% CI: .13-.57) less likely to receive FOBT. CONCLUSIONS While screening disparities were largest among persons without insurance and a usual source of care, more research is needed to understand the influence of Reactions to Race-based treatment as an additional barrier to CRC screening.