Trends in Colorectal Cancer Testing Among Medicare Subpopulations

Department of Family and Community Medicine, University of California Davis, 4860 Y Street, Suite 2300, Sacramento CA 95817, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 07/2008; 35(3):194-202. DOI: 10.1016/j.amepre.2008.05.029
Source: PubMed


In 1998, Medicare initiated universal coverage for colorectal cancer (CRC) screening via fecal occult blood testing (FOBT) and sigmoidoscopy. In mid-2001, universal coverage was advanced to screening colonoscopy. This study sought to determine whether trends in CRC testing differed among racial/ethnic, age, or gender subgroups of the Medicare population.
In 2006, claims from 1995 to 2003 were analyzed for annual 5% random samples of fee-for-service Medicare enrollees living in Surveillance, Epidemiology, and End Results (SEER) regions to calculate the annual, age-standardized percentages of subjects who received FOBT, sigmoidoscopy, or colonoscopy. Logistic regression then modeled trends in annual test use within racial/ethnic, age, and gender subgroups across three Medicare coverage periods (precoverage [1995-1997]; limited coverage [1998-mid-2001]; and full coverage [mid-2001-2003]).
The annual use of FOBT and sigmoidoscopy declined from 1995 to 2003 in all racial/ethnic groups, but the relative decline in sigmoidoscopy use was greater among whites compared to nonwhites. In contrast, colonoscopy use increased substantially in all racial/ethnic groups. However, relative to the precoverage period among whites, the full-coverage period was associated with significantly greater colonoscopy use among whites (OR=2.14; 95% CI=2.09, 2.19) than blacks (OR=1.86; 95% CI=1.75, 1.96); Asian/Pacific Islanders (OR=1.73; 95% CI=1.62, 1.86); or Hispanics (OR=1.65; 95% CI=1.49, 1.81). The use of colonoscopy during the full-coverage period was also differentially greater among enrollees aged <80 years. CRC testing trends were similar among male and female enrollees.
Colonoscopy is supplanting sigmoidoscopy as a CRC test among Medicare enrollees, while FOBT use is in decline. The transition from sigmoidoscopy to colonoscopy has occurred more quickly among white than nonwhite Medicare enrollees.

Download full-text


Available from: Laura-Mae Baldwin, Oct 07, 2014
  • Source
    • "a limited number of articles , and none focused on CHCs serving Asian American , Native Hawaiian , and other Pacific Islander populations . Many EBIs have been developed to increase cancer screening rates . Racial and ethnic minorities , especially Asian Americans , are disproportionately under - screened for cancer , including colorectal cancer ( Fenton et al . , 2008 ; Jerant et al . , 2008 ; Klabunde et al . , 2011 ) . While colorectal cancer incidence and mortality have declined over the last 25 years due to advances in screening and treatment ( Jemal et al . , 2010 ; Naylor et al . , 2012 ) , these improvements have not been shared equally by all groups ( Ayanian , 2010 ; Howlader et al . , 2012 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Understanding and enhancing change capabilities, including Practice Adaptive Reserve (PAR), of Community Health Centers (CHCs) may mitigate cancer-related health disparities. Materials and methods: Using stratified random sampling, we recruited 232 staff from seven CHCs serving Asian Pacific Islander communities to complete a self-administered survey. We performed multilevel regression analyses to examine PAR composite scores by CHC, position type, and number of years worked at their clinic. Results: The mean PAR score was 0.7 (s.d. 0.14). Higher scores were associated with a greater perceived likelihood that clinic staff would participate in an evidence-based intervention (EBI). Constructs such as communication, clinic flow, sensemaking, change valence, and resource availability were positively associated with EBI implementation or trended toward significance. Conclusions: PAR scores are positively associated with perceived likelihood of clinic staff participation in cancer screening EBI. Future research is needed to determine PAR levels most conducive to implementing change and to developing interventions that enhance Adaptive Reserve.
    Asian Pacific journal of cancer prevention: APJCP 12/2013; 14(12):7451-7. DOI:10.7314/APJCP.2013.14.12.7451 · 2.51 Impact Factor
  • Source
    • "Ethnic and racial disparities in receipt of CRC screening and other pre - ventive services have been well described ( AMA Council on Ethical , Judicial Affairs 1990 ; Byrd 1990 ; Zuvekas and Taliaferro 2003 ; Meissner et al . 2006 ; Fenton et al . 2008 ; Atlas et al . 2009 ; Doubeni et al . 2010a , b ; Henley et al . 2010 ) . Prior studies have shown that having a PCP is associated with higher rates of mammography screening ( Atlas et al . 2009 ) . The effect of having a PCP on CRC screening has also been observed previously ( O ' Malley et al ."
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine whether having a primary care physician (PCP) is associated with reduced ethnic disparities for colorectal cancer (CRC) screening and whether clustering of minorities within PCPs contributes to the disparities. Retrospective cohort study of Medicare beneficiaries age 66–75 in 2009 in Texas. The percentage of beneficiaries up to date in CRC screening in 2009 was stratified by race/ethnicity. Multilevel models were used to study the effect of having a PCP and PCP characteristics on the racial and ethnic disparities on CRC screening. Medicare data from 2000 to 2009 were used to assess prior CRC screening. Odds of undergoing CRC screening were more than twice as high in patients with a PCP (OR = 2.05, 95 percent CI 2.03–2.07). After accounting for clustering and PCP characteristics, the black–white disparity in CRC screening rates almost disappears and the Hispanic–white disparity decreases substantially. Ethnic disparities in CRC screening in the elderly are mostly explained by decreased access to PCPs and by clustering of minorities within PCPs less likely to screen any of their patients.
    Health Services Research 06/2012; 48(1). DOI:10.1111/j.1475-6773.2012.01433.x · 2.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal cancer (CRC) screening remains underutilized. The objective of this study was to examine the impact of primary care and economic barriers to health care on CRC testing relative to the 2001 Medicare expansion of screening coverage. Medicare Current Beneficiary Survey data were use to study community-dwelling enrollees aged 65 to 80 years, free of renal disease and CRC, and who participated in the survey in 2000 (n = 8,330), 2003 (n = 7,889), or 2005 (n = 7,614). Three outcomes were examined: colonoscopy/sigmoidoscopy within 5 years (recent endoscopy), endoscopy more than 5 years previously, and fecal occult blood test (FOBT) within 2 years. Endoscopy use increased and FOBT use decreased during the 6-year period, with no significant independent differences between those receiving care from primary care physicians and those receiving care from other physicians. Beneficiaries without a usual place of health care were the least likely to undergo CRC testing, and that gap widened with time: adjusted odds ratio (AOR) = 0.27 (95% confidence interval [CI], 0.19-0.39) for FOBT, and AOR = 0.35 (95% CI, 0.27-0.46) for endoscopy in 2000 compared with AOR = 0.18 (95% CI, 0.11-0.30) for FOBT and AOR = 0.22 (95% CI, 0.17-0.30) for endoscopy in 2005. Disparities in use of recent endoscopy by type of health insurance coverage in both 2000 and 2005 were greater for enrollees with a high school education or higher than they were for less-educated enrollees. There were no statistically significant differences by delayed care due to cost after adjustment for health insurance. Despite expanding coverage for screening, complex CRC screening disparities persisted based on differences in the usual place and cost of health care, type of health insurance coverage, and level of education.
    The Annals of Family Medicine 07/2010; 8(4):299-307. DOI:10.1370/afm.1112 · 5.43 Impact Factor
Show more