Yuhua Bao|Sarah Fox|José J. Escarce
Socioeconomic and Racial/Ethnic Differences in the Discussion of Cancer Screening: “Between?” versus “Within?” Physician Differences
University of North Carolina at Charlotte|Community Partners|University of California, Los Angeles
determine extent socioeconomic racialethnic differences cancer screening discussion patient hisher primary care physician due withinphysician differences fact patients treated differently physicians versus betweenphysician differences treated different group physicianswe use data baseline patient physician surveys two community trials communication medical care cmc research series two studies combined provide analysis sample 5978 patients ages 5080 nested within 191 primary care physicians practiced throughout southern californiaour main outcomes interest whether physician ever talked patient fecal occult blood test fobt colorectal cancer screening mammogram breast cancer screening female patients prostatespecific antigen test psa male patients consider five racialethnic groups nonhispanic white nonhispanic black hispanic asian raceethnicity measure socioeconomic status income education type cancer screening discussion first estimate probit model includes patient characteristics covariates assess overall differences add physician fixed effects derive estimates within versus physician differencesthere strong education gradient discussion three types cancer screening education differences arose within physicians disparities income less consistent across different screening methods seemed arisen mainly betweenphysician differences asians much less likely compared whites received discussion fobt psa differences mainly withinphysician differences black female patients however much likely compared whites treated physicians discussed mammogram physiciansdifferences cancer screening discussion along different dimensions patient ses may arisen different mechanisms therefore call combination interventions physicians need aware persistent disparities patient education clinical communication regarding cancer screening tailor efforts needs loweducation patients qualityimprovement efforts targeted physicians practicing lowincome communities may also effective addressing disparities cancer screening communication patient income