Disparities in colon cancer screening in the medicare population

被引:107
作者
Ananthakrishnan, Ashwin N.
Schellhase, Kenneth G.
Sparapani, Rodney A.
Laud, Purushottam W.
Neuner, Joan M.
机构
[1] Med Coll Wisconsin, Ctr Patient Care & Outcomes Res, Dept Med, Milwaukee, WI 53226 USA
[2] Med Coll Wisconsin, Ctr Patient Care & Outcomes Res, Dept Family & Community Med, Milwaukee, WI 53226 USA
[3] Med Coll Wisconsin, Ctr Patient Care & Outcomes Res, Hlth Policy Inst, Milwaukee, WI 53226 USA
[4] Med Coll Wisconsin, Div Biostat, Milwaukee, WI 53226 USA
关键词
COLORECTAL-CANCER; AVERAGE-RISK; COLONOSCOPY; LITERACY; STAGE; REIMBURSEMENT; SURVEILLANCE; GUIDELINES; NEOPLASIA; KNOWLEDGE;
D O I
10.1001/archinte.167.3.258
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Colorectal cancer is the third most common cancer in the United States, but the rate of screening remains low. Since 2001, Medicare has provided coverage of colonoscopy for colorectal cancer screening in individuals at average risk, but little is known about the effect of this coverage on screening or disparities in screening practices. Methods: We examined the Medicare physician/supplier billing claims file for New York, Florida, and Illinois for the years 2002 and 2003. Using a previously employed algorithm, we identified the rates of colorectal screening tests in individuals at average risk. We performed multivariate logistic regression analysis to calculate the effects of sex, racial/ethnic, and socioeconomic characteristics on screening. We also looked for interactions between socioeconomic and demographic variables. Results: A total of 596 470 Medicare beneficiaries were included in the study. Approximately 18.3% of the population had undergone a screening colon test during the study period. Nonwhite persons were less likely to be screened for colorectal cancer than were white persons (relative risk [RR], 0.52; 95% confidence interval [CI], 0.50-0.53). The lowest RR of screening colonoscopy in women compared with men was in the oldest age group and the highest income tertile (RR for whites, 0.64; 95% CI, 0.59-0.70). Higher income level was associated with screening colonoscopy in white patients (men: RR, 1.19; 95% CI, 1.14-1.25; women: RR, 1.09; 95% CI, 1.05-1.15) but not in nonwhite patients (men: RR, 0.97; 95% CI, 0.78-1.22; women: RR, 0.94; 95% CI, 0.78-1.14). Conclusion: Despite the expansion of Medicare coverage for colorectal cancer screening, there still remain significant disparities between sex and racial/ethnic groups in screening practices.
引用
收藏
页码:258 / 264
页数:7
相关论文
共 40 条
[1]  
[Anonymous], MMWR MORB MORTAL WKL
[2]  
[Anonymous], 1997, IARC SCI PUBLICATION
[3]   Explaining black-white differences in receipt of recommended colon cancer treatment [J].
Baldwin, LM ;
Dobie, SA ;
Billingsley, K ;
Cai, Y ;
Wright, GE ;
Dominitz, JA ;
Barlow, W ;
Warren, JL ;
Taplin, SH .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2005, 97 (16) :1211-1220
[4]   Correlates of colorectal cancer testing in Massachusetts men and women [J].
Brawarsky, P ;
Brooks, DR ;
Mucci, LA .
PREVENTIVE MEDICINE, 2003, 36 (06) :659-668
[5]  
*CDCP, 1999, MMWR-MORBID MORTAL W, V48, P116
[6]   Differences in colorectal carcinoma stage and survival by race and ethnicity [J].
Chien, C ;
Morimoto, LM ;
Tom, J ;
Li, CI .
CANCER, 2005, 104 (03) :629-639
[7]   The role of inadequate health literacy skills in colorectal cancer screening [J].
Davis, TC ;
Dolan, NC ;
Ferreira, MR ;
Tomori, C ;
Green, KW ;
Sipler, AM ;
Bennett, CL .
CANCER INVESTIGATION, 2001, 19 (02) :193-200
[8]   Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: Does literacy make a difference? [J].
Dolan, NC ;
Ferreira, MR ;
Davis, TC ;
Fitzgibbon, ML ;
Rademaker, A ;
Liu, D ;
Schmitt, BP ;
Gorby, N ;
Wolf, M ;
Bennett, CL .
JOURNAL OF CLINICAL ONCOLOGY, 2004, 22 (13) :2617-2622
[9]   Are racial disparities in health conditional on socioeconomic status? [J].
Farmer, MM ;
Ferraro, KF .
SOCIAL SCIENCE & MEDICINE, 2005, 60 (01) :191-204
[10]   Association between colonic screening, subject characteristics, and stage of colorectal cancer [J].
Fazio, L ;
Cotterchio, M ;
Manno, M ;
McLaughlin, J ;
Gallinger, S .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2005, 100 (11) :2531-2539