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The role of access to a primary care physician in mediating immigration-based disparities in colorectal screening: Application of multiple mediation methods

TitleThe role of access to a primary care physician in mediating immigration-based disparities in colorectal screening: Application of multiple mediation methods
Year of Publication2019
AuthorsBlair, A., Gauvin L., Schnitzer M. E., and Datta G. D.
JournalCancer Epidemiology, Biomarkers and Prevention
Volume28
Pages650 - 658
Abstract

Background: Colorectal cancer screening participation is lower among recent immigrants than among Canadian-born individuals. We assessed whether this screening disparity is mediated by access to regular primary care physicians (PCP). Methods: Pooling years 2003 to 2014 of the Canadian Community Health Survey, lifetime screening in respondents aged 50 to 75 years of age who immigrated in the previous 10 years (n = 1,067) was compared with Canadian-born respondents (N = 102,366). Regression- and inverse probability weighting-based methods were used to estimate the total effect (TE) and controlled direct effect (CDE) of recent immigration on never having received either a stool- or endoscopic-based screening test. The proportion of the TE that would be eliminated if all had a PCP was computed using these estimates [proportion eliminated (PE) = (TE - CDE)/(TE - 1)]. Analyses were stratified by visible minority status and adjusted for income, rurality, age, sex, marital status, education, and exposure to a provincially organized colorectal screening program. Results: The prevalence of never having been screened was 71% and 57% in visible minority and white recent immigrants, respectively, and 46% in white Canadian-born respondents. If all had regular PCPs, there would be no reduction in the screening inequality between white recent immigrants and Canadian-born (null PE), and the inequality between visible minority immigrants and white Canadian-born may increase by 6% to 13%. Conclusions: Ensuring all have regular PCPs may lead to greater screening gains among Canadian-born than recent immigrants. Impact: Improving access to PCPs may increase colorectal screening overall, but not reduce immigration-based disparities screening. Alternative interventions to reduce this disparity should be explored.

URLhttp://cebp.aacrjournals.org/content/early/2019/03/26/1055-9965.EPI-18-0825.abstract
DOI10.1158/1055-9965.EPI-18-0825
Document URLhttp://cebp.aacrjournals.org/content/early/2019/03/26/1055-9965.EPI-18-0825.full-text.pdf