Impact of Patient-Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey

• Published in: Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2017-12, Vol.26 (12), p.1804-1811
• Main Authors: Malhotra, Jyoti, Rotter, David, Tsui, Jennifer, Llanos, Adana A M, Balasubramanian, Bijal A, Demissie, Kitaw
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Breast; Breast cancer; Cancer screening; Cervix; Colorectal cancer; Colorectal carcinoma; Continental Population Groups - statistics & numerical data; Cross-Sectional Studies; Discordance; Early Detection of Cancer - economics; Early Detection of Cancer - statistics & numerical data; Ethnic Groups - statistics & numerical data; Ethnicity; Expenditures; Female; Gender; Health Care Surveys - statistics & numerical data; Health Expenditures - statistics & numerical data; Hispanic people; Humans; Male; Mammography; Mass Screening - economics; Mass Screening - statistics & numerical data; Medical screening; Middle Aged; Minority & ethnic groups; Neoplasms - diagnosis; Neoplasms - ethnology; Oncologists - statistics & numerical data; Patients; Physician-Patient Relations; Race; Sex Factors; United States
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.EPI-17-0660

Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive. In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest. Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs. Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study. Our findings highlight the importance of gender concordance in improving cancer screening rates. .