Colorectal cancer is a leading cause of cancer-related death in the United States, ranking third in incidence and deaths. Effective colorectal cancer screening has been shown to reduce the risk of dying from the disease by almost 70%; however, numerous disparities in colorectal cancer continue to be discovered and defined.
Demographic factors, including a patient’s race, ethnicity, gender, education level, poverty, health insurance status, and language, have been linked to a higher or lower risk of screening, while other cultural factors, such as distrust of medical treatment, can also play a role. Understanding the intersection of these social determinants of health is critical to improving health equity and survival rates for disadvantaged populations.
In a retrospective review of patients who had a recent primary care visit in a well-resourced safety-net health system that serves a diverse population, a team led by researchers at Beth Israel Deaconess Medical Center (BIDMC) aimed at better defining the links between patients’ socio-demographic characteristics and colorectal screening.
Assessing self-reported factors including race, ethnicity, preferred language, mental health, and substance use, the team’s more granular assessment provided findings that contradict traditional US health care disparities, with Hispanic and Spanish-speaking patients undergoing screening at significantly higher rates than for white and English-speaking patients. The counterintuitive results, published in Preventive medicinedemonstrate that a health care system designed to provide equal access to screening for underserved patients can address the disparities commonly seen in cancer screening.
“Investing in a multicultural workforce and outreach efforts toward disadvantaged patients may counter some of the implicit or explicit biases seen about health care systems that have led to traditional racial/ethnic disparities,” said corresponding author Heidi J. Rayala, MD, Ph.D., urologist at BIDMC. “Our study showed differences in the odds of successful screening based on traditionally defined subsections of ethnicities, such as the breakdown of ‘Hispanic’ into more specific cultures and backgrounds, suggesting that future research should focus on better understanding individual cultures and communities, rather than cramming patients into excessively large groups.”
Rayala, who is also an assistant professor of surgery at Harvard Medical School, and colleagues examined the anonymous records of more than 22,000 patients aged 50 to 75 who saw a primary care physician at the Cambridge Health Alliance (CHA) in Since 2018 as of 2019. CHA is a state-funded urban health system in the greater Boston area consisting of 13 primary care centers and two hospitals.
Intended to provide health care services to low-income, medically under-resourced residents, CHA serves a 63% non-white patient population, with 43% of patients having limited English proficiency and 51% having a Medicaid insurance. CHA is well resourced in interpretation services and mental health services and has focused on finding ways to improve health equity. CHA is affiliated with BIDMC and the two organizations have a long history of working together to expand access to care in local communities.
Of the 22,000 patients included in the study, 16,065 underwent colorectal screening, an overall screening rate of 73%. While that rate is on par with overall Massachusetts colorectal screening rates, the state numbers reflect national racial and ethnic disparities, where people of color are not screened as often as whites. Massachusetts numbers show a screening rate of 56% of Hispanic individuals and 68% of Black individuals compared to 76% of Whites.
In contrast, at the CHA, Hispanics had the highest screening rates of 78%. Rayala and colleagues further subdivided the participants according to more granular demographic factors, finding that 79% of Portuguese/Azorean ethnicity received screening. Spanish speakers in general had the highest screening rate of nearly 80%.
Among all CHA patients, there were no differences in screening rates between patients with or without obesity, nor was neighborhood income level associated with differences in screening, although commercially insured patients screened at higher rates than to those covered by Medicare or Medicaid. Patients with substance use disorder or a serious mental health diagnosis both had lower rates of screening. Similarly, white patients had the lowest screening rates at 69%. The researchers say these data points are likely related, as the white population in this safety net population had significantly higher rates of serious mental illness and substance use disorders.
“Non-Hispanic white patients had the lowest colorectal screening rates, highlighting an opportunity to evaluate barriers to screening within a safety-net population in an ethnic group that is generally reported to have colorectal screening rates. higher screenings,” said first author Benjamin G. Allar, a general surgery resident at the BIDMC and chief investigator in the Center for Surgery and Public Health at Brigham and Women’s Hospital. “Our white population also had a significantly higher incidence of severe mental health and substance use disorder diagnoses, which resulted in a 17 percent reduction in the odds of screening for people with substance use disorder. Studies Future projects may examine the intersectionality of substance use disorder and race and ethnicity in safety net populations in relation to cancer screening.”
Benjamin G. Allar et al, Colorectal cancer screening in a safety-net health care system: The intersectional impact of race, ethnicity, language, and mental health, Preventive medicine (2022). DOI: 10.1016/j.ypmed.2022.107389
Provided by Beth Israel Deaconess Medical Center
Quote: Targeted Care Reverses Racial/Ethnic Health Disparities in Colon Cancer Screening, Researchers Find (2023, Jan 9) Retrieved Jan 9, 2023 from https://medicalxpress.com/news/2023-01-reverses -racialethnic-health-disparities-colon .html
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