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HEALTH DISPARITIES AND COLORECTAL CANCER SCREENING

By Dr. Clark Hinderleider
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The term health disparities refers to population-specific differences in the presence of disease, health outcomes, quality of health care and access to health care services that exist across racial and ethnic groups.  Many socioeconomic and health factors contribute to health disparities including inadequate access to care, poor quality of care, genetics, community features, and personal behavior.  Individuals living in both urban and rural areas may experience these.  D.A. Alter in his paper notes, “Countries contemplating national health insurance cannot rely on universal care to eliminate historical disparities in outcomes suffered by disadvantaged groups.  Universal care can only reduce these disparities.”  He concludes,

“Our findings suggest the need to introduce large scale preventive strategies early in patients’ lives to help change unhealthy behavior.”  Hopkins Center for Health Disparities Solutions is addressing these. 

The Institute of Medicine has long been interested this issue.  The recent HHS report states that health care disparities persist as low-income Americans and racial and ethnic minorities continue to have higher incidences of disease, fewer treatment options and less access to care.  Forty percent of low-income Americans do not have health insurance; half of the total of the uninsured are poor; and one-third of the uninsured have a chronic disease.  It is important to note that Section 10334 of the Patient Protection and Affordable Care Act (PPACA) establishes infrastructure to address and reduce these disparities.

Released as an MMWR Supplement, the Centers for Disease Control and Prevention (CDC) has issued the CDC Health Disparities and Inequalities Report─United States, 2011.  The report contains 22 topical essays which provide an analysis of the recent trends and ongoing variations in these in selected social and health indicators.

To estimate disparities in rates of use of colorectal cancer tests and evaluate changes in test use, CDC compared data from the 2002, 2004, 2006, and 2008 Behavioral Risk Factor Surveillance System surveys. Probably the most significant finding of this section, especially in the current context of debate about health care reform, is that the proportion obtaining appropriate screen was greater for persons with health insurance, compared to those without health insurance.  As with cancer screening tests, disparities are evident in cancer incidence.

There is a clinically useful, brief fact sheet which summarizes this information for the primary care provider.  The section authors conclude, “Coordinated efforts by CDC and other federal agencies, state and local health departments, and the medical community to address barriers and disparities in screening should be continued so that the incidence of and comorbidities associated with colorectal cancer can be reduced among all populations.”

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