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To the Editor: Dr Lieberman and colleagues¹ studied the prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. In that article and the accompanying Editorial by Drs Roy and Bianchi,² biological differences between black and white patients were noted as contributing to observed differences in the incidence of colon polyps and colorectal cancer. The article by Lieberman stated, "There is considerable evidence that tumor biology and genetics play a role in some of the racial differences," and the Editorial stated, "There are myriad potential explanations including both societal issues (access to health care) and biological differences. . . . "

Comparisons of disease incidence or outcomes between racial groups are problematic if they consider the groups to be homogeneous. Most health disparities that appear to be based on race are instead based on differences in socioeconomic status that overlap imperfectly with race.³ Treating all persons within a racial group . . . [Full Text of this Article]

Donald A. Barr, MD, PhD
barr@stanford.edu
Department of Sociology
Stanford University
Stanford, California

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