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Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care.
J Gen Intern Med. 2003 Dec; 18(12):1028-35.JG

Abstract

CONTEXT

Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace.

OBJECTIVE

To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening.

DESIGN, SETTING, AND SUBJECTS

Cross-sectional study using 1998 data from the National Health Interview Survey.

MAIN OUTCOME MEASURES

Completion of cervical, breast, or colorectal cancer screening.

RESULTS

Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82), Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents.

CONCLUSION

Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born.

Authors+Show Affiliations

Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. mgoel@caregroup.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14687262

Citation

Goel, Mita Sanghavi, et al. "Racial and Ethnic Disparities in Cancer Screening: the Importance of Foreign Birth as a Barrier to Care." Journal of General Internal Medicine, vol. 18, no. 12, 2003, pp. 1028-35.
Goel MS, Wee CC, McCarthy EP, et al. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med. 2003;18(12):1028-35.
Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18(12), 1028-35.
Goel MS, et al. Racial and Ethnic Disparities in Cancer Screening: the Importance of Foreign Birth as a Barrier to Care. J Gen Intern Med. 2003;18(12):1028-35. PubMed PMID: 14687262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. AU - Goel,Mita Sanghavi, AU - Wee,Christina C, AU - McCarthy,Ellen P, AU - Davis,Roger B, AU - Ngo-Metzger,Quyen, AU - Phillips,Russell S, PY - 2003/12/23/pubmed PY - 2004/5/5/medline PY - 2003/12/23/entrez SP - 1028 EP - 35 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 18 IS - 12 N2 - CONTEXT: Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace. OBJECTIVE: To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening. DESIGN, SETTING, AND SUBJECTS: Cross-sectional study using 1998 data from the National Health Interview Survey. MAIN OUTCOME MEASURES: Completion of cervical, breast, or colorectal cancer screening. RESULTS: Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82), Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents. CONCLUSION: Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born. SN - 0884-8734 UR - https://www.unboundmedicine.com/medline/citation/14687262/Racial_and_ethnic_disparities_in_cancer_screening:_the_importance_of_foreign_birth_as_a_barrier_to_care_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=2003&volume=18&issue=12&spage=1028 DB - PRIME DP - Unbound Medicine ER -