Low uptake of colorectal cancer screening among African Americans in an integrated Veterans Affairs health care network.

African Americans have the highest incidence and mortality from colorectal cancer (CRC). Despite guidelines to initiate screening with colonoscopy at age 45 in African Americans, the CRC incidence remains high in this group. To examine the rates and predictors of CRC screening uptake as well as time to screening in a population of African Americans and non-African Americans in a health care system that minimizes variations in insurance and access. Retrospective cohort study. Greater Los Angeles Veterans Affairs (VA) Healthcare System. Random sample (N = 357) of patients eligible for initial CRC screening. Uptake of any screening method; uptake of colonoscopy, in particular; predictors of screening; and time to screening in African Americans and non-African Americans. The overall screening rate by any method was 50%. Adjusted rates for any screening were lower among African Americans than non-African Americans (42% vs 58%; odds ratio [OR] 0.49; 95% confidence interval [CI], 0.31-0.77). Colonoscopic screening was also lower in African Americans (11% vs 23%; adjusted OR 0.43; 95% CI, 0.24-0.77). In addition to race, homelessness, lower service connectedness, taking more prescription drugs, and not seeing a primary care provider within 2 years of screening eligibility predicted lower uptake of screening. Time to screening colonoscopy was longer in African Americans (adjusted hazard ratio 0.43; 95% CI, 0.25-0.75). The sample may not be generalizable. We found marked disparities in CRC screening despite similar access to care across races. Despite current guidelines aimed at increasing CRC screening in African Americans, participation in screening remained low, and use of colonoscopy was infrequent.

May FP ，Bromley EG ，Reid MW ，Baek M ，Yoon J ，Cohen E ，Lee A ，van Oijen MG ，Spiegel BM ... -  《-》

Race, Poverty, and Mental Health Drive Colorectal Cancer Screening Disparities in the Veterans Health Administration.

May FP ，Yano EM ，Provenzale D ，Steers WN ，Washington DL ... -  《-》

Predictors of stage of adoption for colorectal cancer screening among African American primary care patients.

Wang HL ，Christy SM ，Skinner CS ，Champion VL ，Springston JK ，Perkins SM ，Tong Y ，Krier C ，Gebregziabher N ，Rawl SM ... -  《-》

Persisting Racial Disparities in Colonoscopy Screening of Persons with a Family History of Colorectal Cancer.

Tsai MH ，Xirasagar S ，de Groen PC 《-》

Explaining persistent under-use of colonoscopic cancer screening in African Americans: a systematic review.

Although African Americans have the highest incidence and mortality from colorectal cancer (CRC), they are less likely than other racial groups to undergo CRC screening. Previous research has identified barriers to CRC screening among African Americans. However we lack a systematic review that synthesizes contributing factors and informs interventions to address persistent disparities. We conducted a systematic review to evaluate barriers to colonoscopic CRC screening in African Americans. We developed a conceptual model to summarize the patient-, provider-, and system-level barriers and suggest strategies to address these barriers. Nineteen studies met inclusion criteria. Patient barriers to colonoscopy included fear, poor knowledge of CRC risk, and low perceived benefit of colonoscopy. Provider-level factors included failure to recommend screening and knowledge deficits about guidelines and barriers to screening. System barriers included financial obstacles, lack of insurance and access to care, and intermittent primary care visits. There are modifiable barriers to colonoscopic CRC screening among African Americans. Future interventions should confront patient fear, patient and physician knowledge about barriers, and access to healthcare services. As the Affordable Care Act aims to improve uptake of preventive services, focused interventions to increase CRC screening in African Americans are essential and timely.

Bromley EG ，May FP ，Federer L ，Spiegel BM ，van Oijen MG ... -  《-》