Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50

Year: 2016

Type: article

Abstract: Understanding multilevel predictors of colorectal cancer (CRC) screening test modality can help inform screening program design and implementation. We used North Carolina Medicare, Medicaid, and private, commercially available, health plan insurance claims data from 2003 to 2008 to ascertain CRC test modality among people who received CRC screening around their 50th birthday, when guidelines recommend that screening should commence for normal risk individuals. We ascertained receipt of colonoscopy, fecal occult blood test (FOBT) and fecal immunochemical test (FIT) from billing codes. Person-level and county-level contextual variables were included in multilevel random intercepts models to understand predictors of CRC test modality, stratified by insurance type. Of 12,570 publicly-insured persons turning 50 during the study period who received CRC testing, 57% received colonoscopy, whereas 43% received FOBT/FIT, with significant regional variation. In multivariable models, females with public insurance had lower odds of colonoscopy than males (odds ratio [OR] = 0.68; p < 0.05). Of 56,151 privately-insured persons turning 50 years old who received CRC testing, 42% received colonoscopy, whereas 58% received FOBT/FIT, with significant regional variation. In multivariable models, females with private insurance had lower odds of colonoscopy than males (OR = 0.43; p < 0.05). People living 10-15 miles away from endoscopy facilities also had lower odds of colonoscopy than those living within 5 miles (OR = 0.91; p < 0.05). Both colonoscopy and FOBT/FIT are widely used in North Carolina among insured persons newly age-eligible for screening. The high level of FOBT/FIT use among privately insured persons and women suggests that renewed emphasis on FOBT/FIT as a viable screening alternative to colonoscopy may be important.

Source: Preventive Medicine Reports

DOI: 10.1016/j.pmedr.2016.11.019

Authors: Stephanie B. Wheeler, Tzy-Mey Kuo, Anne Marie Meyer, Christa E. Martens, Kristen M. Hassmiller Lich, Florence K.L. Tangka, Lisa C. Richardson, Ingrid J. Hall, Judith Lee Smith, Maria E. Mayorga, Paul Brown, Trisha M. Crutchfield, Michael P. Pignone

Institutions: University of North Carolina at Chapel Hill, UNC Lineberger Comprehensive Cancer Center, Centers for Disease Control and Prevention, North Carolina State University, University of California, Merced

Language: English

Topic: Colorectal Cancer Screening and Detection

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $2,610

Funders: National Science Foundation, University of North Carolina, National Institutes of Health, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, National Cancer Institute, National Center for Chronic Disease Prevention and Health Promotion, Division of Civil, Mechanical and Manufacturing Innovation, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill

OpenAlex ID: W2560770787