The authors declare no conflicts of interest related to the study or any of the related published material. Although we do not feel this factor affects the overall findings or conclusions of the study, it is worth noting. In fact, an assumption is often made in most health service studies that health insurance status and having a primary care clinician are proxy measures of a similar construct. Eradicating health disparities is a primary Healthy People objective, and creating evidence about contributing factors may result in health-policy-driven solutions. Non-Hispanic African Americans were significantly less likely to be up-to-date for colorectal cancer testing in the univariate analysis; however, non-Hispanic African Americans were significantly more likely to be up-to-date for colorectal cancer testing compared with non-Hispanic whites after controlling for having a personal health care provider, education, income, age, sex, and health insurance status. This study attempted to mirror the US Preventive Services Task Force recommendations because the BRFSS was used for colorectal cancer screening, 39 but the BRFSS questions did not include barium enema testing and did not distinguish sigmoidoscopy from colonoscopy testing, because recommended screening intervals differ 5 years vs 10 years, respectively.
If this screening test was his first for colorectal cancer by any modality , he technically would have been inadequately screened, because testing should have commenced at the age of 50 years with appropriate follow-up intervals. In addition, although telephone surveys are easy to conduct and cost-effective, they may introduce potential biases. For example, a year-old man who had a fecal occult test within the last year would be classified as up-to-date but not necessarily adequately screened. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center on Minority Health and Health Disparities or the National Institutes of Health. That is, those with 1 or more than 1 personal health care provider were approximately 3 times more likely to be up-to-date for colorectal cancer testing. There are several limitations to this study. For example, physician recommendation becomes a moot issue if the patient does not have a medical home or someone he or she considers as a primary care clinician. Another study by Etzoni et al concluded that insurance coverage and having a usual source of care were the most important predictors of colorectal cancer testing. These findings suggest that policy-driven initiatives to ensure all people, regardless of socioeconomic and health insurance status, have access to a primary care clinician may be a strategic method to improving colorectal cancer screening rates and other health service outcomes. A common limitation to research using secondary cross-sectional data is the inability to correctly assess up-to-date vs adequacy of colorectal cancer screening. The authors declare no conflicts of interest related to the study or any of the related published material. Finally, the cross-sectional nature of this study precludes any determinations of causality. Accepted for publication June 30, Eradicating health disparities is a primary Healthy People objective, and creating evidence about contributing factors may result in health-policy-driven solutions. Those households without a home telephone are more likely to include persons who have lower incomes and less education, who live in rural areas, and who are in poor health, which casts doubt on the generalizability of the findings to the national population. Although we do not feel this factor affects the overall findings or conclusions of the study, it is worth noting. Although other covariates remained, or became, significant predictors, having a personal health care provider had the highest odds of predicting being up-to-date for colorectal cancer testing. Received for publication February 19, Previous studies have found patient-level factors ie, lack of knowledge , 24 , 25 clinician-level factors ie, offering colorectal cancer screening , 22 , 26 — 28 socioeconomic factors ie, education, income , 29 — 31 and system-level factors ie, health insurance status 32 , 33 to be barriers and facilitators to colorectal cancer screening. In addition, as mentioned earlier, personal health care provider does not differentiate primary care from non—primary care or physician from mid-level clinicians. Nonetheless, the findings of this study do not diminish that being up-to-date in cancer screening is a multifaceted problem, because this study does not account for patient-level, clinician-level, and environmental-level factors. Ross et al found lack of health insurance to be associated with a significant decrease in use of preventive services. In addition, as discussed earlier, the BRFSS colorectal cancer questions asked about test use but did not differentiate the purpose of having the test s screening or diagnostic. This study attempted to mirror the US Preventive Services Task Force recommendations because the BRFSS was used for colorectal cancer screening, 39 but the BRFSS questions did not include barium enema testing and did not distinguish sigmoidoscopy from colonoscopy testing, because recommended screening intervals differ 5 years vs 10 years, respectively. In fact, an assumption is often made in most health service studies that health insurance status and having a primary care clinician are proxy measures of a similar construct.
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