An examination of the use of endoscopy screening tests for colorectal cancer among African American medicare beneficiaries in the northwest region of Louisiana

Abstract

African Americans (AA) are more likely to be diagnosed and die from late-stage colorectal cancer (CRC) than other US population groups (ACS, 2011a). This specific disparity persists even though CRC deaths can be reduced by as much as 60% through screening (CDC, 2011c). Health or CRC disparities are not new phenomena, but the causes and determinants can be quite complex among AA population groups throughout the US.

The health of African Americans typically lags behind their white counterparts both nationally and in Louisiana. From 2003 - 2007, the highest CRC incidence rate for AA was seen in the state of Louisiana (Hsieh et al., 2010). The National Cancer Institute (2010) reported all states had achieved the Healthy People 2010 objective of 50% compliance for CRC screening, but Louisiana had the lowest reported screening rate of 52.6% using endoscopy studies.

Aggregated national and state health data can be problematic in isolating cause-effect relationships and health determinants. Using a parish-level unit of analysis, this research study sought to examine endoscopy CRC screening compliance among AA Medicare beneficiaries with fee-for-service health coverage and examine relationships with factors that may predict or mediate screening behaviors. Isolated to two neighboring parishes in northwest Louisiana, Sabine and Natchitoches parishes, primary data collection was launched from African American churches.

The dependent variable was CRC screening compliance and primary independent variables were age, gender, self-reported prior CRC knowledge and physician recommendation. Independent sample t-testing was employed to analyze inter-parish and combined sample CRC screening rates, and whether CRC screening compliance was associated with age, gender, self-reported prior CRC knowledge and physician recommendation. The results showed age and gender were not associated with CRC screening compliance using endoscopy studies, at α = 0.05. However, self-reported prior CRC knowledge and physician recommendation were associated with CRC screening compliance. Further logistic regression analysis showed participants with a minimum prior CRC knowledge score of 3 were 18.5 times more likely to be in compliance using endoscopy. This research study demonstrated how crucial isolating health and community data for a specific population subgroup and location can become in efforts to eliminate health disparities.