Dataset Information

Predictors of Colorectal Cancer Screening Modality Among Newly Age-Eligible Medicaid Enrollees.

ABSTRACT:

Introduction

This study examines individual- and practice-level predictors of screening modality among 1,484 Medicaid enrollees who initiated colorectal cancer screening (fecal immunochemical test/fecal occult blood tests or colonoscopy) within a year of turning age 50 years. Understanding screening modality patterns for patients and health systems can help optimize colorectal cancer screening initiatives that will lead to high screening completion rates.

Methods

Multivariable logistic regression was conducted in 2019 to analyze Medicaid claims data (January 2013-June 2015) to explore predictors of colonoscopy screening (versus fecal testing).

Results

Overall, 64% of enrollees received a colonoscopy and 36% received a fecal immunochemical test/fecal occult blood test. Male (OR=1.21, 95% CI=1.08, 1.37) compared with female enrollees and those with 4-6 (OR=1.57, 95% CI=1.15, 2.15), 7-10 (OR=2.23, 95% CI=1.64, 3.03), and ≥11 (OR=1.79, 95% CI=1.22, 2.65) primary care visits compared with 0-3 visits had higher odds of colonoscopy screening. Non-White, non-Hispanic enrollees (OR=0.71, 95% CI=0.58, 0.87) compared with White, non-Hispanics Whites had lower odds of colonoscopy screening. Practices with an endoscopy facility within their ZIP code (OR=1.50, 95% CI=1.08, 2.08) compared with practices without a nearby endoscopy facility had higher odds of colonoscopy screening.

Conclusions

Among newly age-eligible Medicaid enrollees who received colorectal cancer screening, non-White, non-Hispanic individuals were less likely and male enrollees and those with ≥4 primary care visits were more likely to undergo colonoscopy versus fecal immunochemical test/fecal occult blood test. Colonoscopy also was the more common modality among adults whose primary care clinic had an endoscopy facility in the same ZIP code. Future research is needed to fully understand patient, provider, and practice preferences regarding screening modality.

SUBMITTER: Mojica CM

PROVIDER: S-EPMC8493888 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background/AimsSince 1993, the US Preventive Services Task Force has recommended screening to prevent colorectal cancer among average risk adults, beginning at age 50. Many studies over the past 20 years evaluated factors associated with screening uptake; however, few have focused on individuals who are newly eligible (i.e., those turning 50 years). We evaluated patient characteristics associated with uptake and time to initiation of colorectal cancer tests in a population newly-eligible for screening.MethodsThe study included 128,358 individuals who were members of an integrated care delivery system (Group Health) and enrolled on their 50th birthday from 1996–2011. We assessed receipt of colorectal cancer tests within 5 years of eligibility, and calculated the median time to first test. We examined patient characteristics associated with use of colorectal cancer tests overall using Cox proportional hazards models.ResultsStool-based tests were most commonly used, with uptake ranging from 35–40% of the cohort across the study period. The proportion of individuals initiating colorectal cancer testing via colonoscopy increased from 3% in members becoming eligible in 1996–1998 to 21% in 2005–2007. Time to first test varied across test types. Median time to the first test was 3 months shorter in members who chose stool-based tests (25.2 months) compared to those who chose colonoscopy (28.2 months) among members newly eligible in 2005–2007. However, we observed no temporal changes in median time to first test, conditional on test type. Characteristics associated with increased uptake included more recent enrollment at age 50 (e.g., 2008–2010:HR = 2.16, 95% CI 2.09–2.23) and Asian background (HR = 1.08, 95% CI 1.05–1.11). Factors associated with reduced uptake included being a woman (HR = 0.93, 95% CI 0.91–0.94), African-American (HR = 0.95, 95% CI 0.91–0.99) or Pacific Islander (HR = 0.86, 95% CI 0.76–0.96), diagnosed with diabetes (HR = 0.88, 95% CI 0.85–0.91) and being moderately or severely obese (HR = 0.83, 95% CI 0.81–0.85 and HR = 0.75, 95% CI 0.73–0.77, respectively).ConclusionsPatient characteristics associated with initiation of colorectal cancer testing in a newly eligible population are similar to previous findings among all-age eligible adults. Further, while the time to the first test remained stable, there was an increase in colorectal cancer testing during the study period.