Colorectal Cancer Screening Disparities in Asian Americans: Exploring Subgroup Differences and Associated Determinants

Purpose: Cancer is the leading cause of death among Asian American men and women. Studies have consistently reported lower cancer screening rates in Asian Americans than non-Hispanic white and African Americans. However, data on subgroup-specific screening disparities in Asian Americans is extremely limited. Methods: This study aims to explore the subgroup differences and related determinants for colorectal cancer (CRC) screening among Asian Americans aged 40 and over who have obtained CRC screening in the previous five years. The cross-sectional 2001, 2003, and 2005 California Health Interview Surveys were merged to obtain a larger sample size for Chinese (N=2,312), Filipino (N=1,176), Japanese (N=871), Korean (N=1,105), Vietnamese (N=1,124), and South Asian (N=449). CRC screening disparities among these subgroups were compared to Whites (N=66,172). STATA 9.0 was used to analyze the weighted data. Results: The findings disclosed that Filipino (30.85%), Korean (23.01%), and South Asian (27.69%) had significantly lower rates of screening as compared to Whites (44.81%). Logistic regression showed that cancer screening disparities still existed in Filipino, South Asian, and Korean Americans after adjusting for socio-demographic and health-related variables and access to health care and immigration factors. However, after controlling for these factors, Vietnamese Americans was identified as a group of having significantly higher rate of screening as compared to Whites. Age, gender, marital status, education, poverty, health insurance, number of chronic disease, usual source of care, language use at home, and length of years in the U.S. were significantly associated with receiving CRC screening. Implications: The findings identified the most vulnerable Asian American groups for colorectal cancer screening disparities and revealed structural and immigration factors as barriers to cancer screening. The results highlight the urgent need for culturally relevant interventions targeting Asian sub-groups. These findings will contribute to the development of ethnic and culture-specific cancer prevention programs, cancer policy, and cancer health education strategies. Further research is needed to explore cultural, social, and attitudinal factors that prevent underserved Asian American groups from obtaining recommended cancer screening.