ASPO Abstracts
Disparities in colorectal cancer screening: Intersectionality of gender, race, and sexual orientation
Category: Early Detection & Risk Prediction, Cancer Health Disparities
Conference Year: 2018
Abstract Body:
Intersectionality theory posits that aspects of identity such race/ethnicity, gender, and sexual orientation influence healthcare utilization through a multitude of sociocultural and behavioral mechanisms (e.g., access to care, employment, healthcare providers, discrimination). The intersectional framework may shed light on known racial/ethnic disparities for colorectal cancer (CRC) screening by examining the interactions between race/ethnicity, gender, and sexual orientation. This study utilized publicly available, de-identified data from the 2014-2016 Behavioral Risk Factor Surveillance Survey to examine the interaction of race/ethnicity (race), sexual orientation (SO), and gender among lifetime CRC screening (stool blood test [FOBT] and endoscopy), as well as being up-to-date (UTD). The analytic sample (n=118,473; 60% female, 82% white, 98% heterosexual) included individuals ages 50+ years. Unweighted logistic regressions were stratified by gender with race (0=white; 1=people of color [POC]), SO (0=heterosexual; 1=sexual minority), and race×SO as predictors of CRC screening (0=no; 1=yes). MALES: Significant findings were identified for FOBT [race×SO: OR=.70, p=.045], endoscopy [race: OR=.70, p<.001; SO: OR=1.19, p=.025], and being UTD [race: OR=.76, p<.001; SO: OR=1.21, p=.020]. Sexual minority POC had the lowest lifetime use of FOBT (27%), followed by heterosexual POC (33%), white heterosexuals (34%), and white sexual minorities (35%). Heterosexual POC had the lowest lifetime use of endoscopy and U2D screenings, respectively, (65% and 68%) followed by sexual minority POC (71% and 72%), white heterosexuals (73% and 73%), and white sexual minorities (76% and 77%). FEMALES: Significant findings were identified for endoscopy [race: OR=.84, p<.001; and race×SO: OR=.56, p=.001] and being U2D [race: OR=.94, p=.006; and race×SO: OR=.55, p=.001]. Sexual minority POC had the lowest lifetime use of endoscopy and U2D screenings, respectively, (60% and 63%) compared to heterosexual POC (70% and 73%), white heterosexuals (73% and 74%), and white sexual minorities (76% and 77%). Findings highlight the importance of intersectionality in identifying risk of underutilization of CRC screening. Tailored education interventions may benefit at-risk subgroups.
Keywords: Cancer Screening; Healthcare Disparities; Sexual and Gender Minorities