Age-based and Sex-based Disparities in Screening Colonoscopy Use Among Medicare Beneficiaries

Abstract

In a large cohort of Medicare beneficiaries, there was evidence of screening colonoscopy use even among patients with a short life expectancy. After accounting for life expectancy, females and older persons were less likely to undergo screening colonoscopy.

Quantifying the defensive medicine contribution to primary care costs

“…However, the atypical presentations could also activate the defensive mechanisms and make physicians order tests to prevent missing a diagnosis, even when they believe the probability of that diagnosis to be extremely low. It might also be due to physician awareness of the facts that, compared to men, women undergo fewer screening procedures 19 and diagnostic tests for certain conditions 20,21 and consequently have more missed diagnoses. Alternatively, women might be better informed than men about some medical conditions 22 and request more testing 23 .…”

Colon Cancer Screening in U.S. Adults Aged 65 and Older According to Life Expectancy and Age

“…Few studies have examined use of CRC screening in older adults based on LE . A study examining colonoscopies performed in Medicare beneficiaries aged 66 and older between 2008 and 2010 found that 24.8% were performed in adults with a LE of less than 10 years .…”

“…These proportions are similar to what was found in the current study—that 28% of older adults are inappropriately screened based on age or LE at the time of screening. A study of screening colonoscopies in Medicare beneficiaries between 2001 and 2005 found that older age and shorter LE were associated with lower likelihood of screening . A study of the receipt of CRC screening in U.S. veterans aged 70 and older in 2001 and 2002 found that 47% of those with a LE greater than 5 years were screened, compared with 41% of those with a LE less than 5 years; FOBT was the predominant screening modality used .…”

Estimating an area-level socioeconomic status index and its association with colonoscopy screening adherence

“…age, gender, education, health insurance coverage, barriers to CRCS, etc.) [5–12], but also area-level influences such as socioeconomic status (SES) [13–22]. To date, CRCS studies have examined single measures or discrete sets of SES indicators with the majority reporting significant associations between lower SES and non-adherence [11, 16–24].…”