Disparities in colorectal screening between US-born and foreign-born populations: evidence from the 2000 National Health Interview Survey

Abstract

Background: Over 11% of the US population in 2002 was foreign born. Studies that have examined disparities of cancer screening often focus on racial/ethnicity differences without considering their origins. This study examines the disparities in colorectal cancer (CRC) screening between US- and foreign-born groups and explores factors associated with such disparities.

Methods: Data were obtained from the 2000 National Health Interview Survey Cancer Control Module. Multivariate logistic models were used to compare the use of CRC screening among the foreign born and 4 US-born race/ethnicity subgroups while controlling for other factors that may affect such screening. Appropriate weighting procedures were employed to account for the complex design of the survey.

Results: Compared with the US-born non-Hispanic Whites, the odds ratio of ever having had a colorectal screening for the US-born Hispanic, non-Hispanic Black, non-Hispanic other races groups, and the foreign-born group with 15 or more years of residency was 0.65, 0.77, 0.98, and 0.58, respectively. An even lower odds ratio (0.46) was found among the foreign-born group with a shorter duration of residency. We found that the rate of screening for foreign-born individuals with good socioeconomic status and/or with health insurance was significantly lower than that of the US-born with similar status, and the rate was not much different from that of US-born individuals in lower socioeconomic levels. Having a usual source of care was found to be the most important protective factor for the foreign-born group.

Conclusions: Foreign birth was associated with a lower rate of CRC screening. Future studies of health disparities should also consider immigration status.