Patterns of Colorectal Cancer Screening Uptake in Newly Eligible Men and Women

Wernli, Karen J.; Hubbard, Rebecca A.; Johnson, Eric A.; Chubak, Jessica; Kamineni, Aruna; Green, Beverly B.; Rutter, Carolyn M.

doi:10.1158/1055-9965.epi-13-1360

Cited by 25 publications

(33 citation statements)

References 27 publications

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“…Before the ACA's elimination of cost‐sharing for preventive services, Medicare enrollees were responsible for up to 20% of allowable charges and, along with privately insured individuals, may have been responsible for a range of costs including co‐pays and meeting deductibles, thereby posing a challenge to receiving CRC screening, particularly among those with fixed incomes. Although our observations are consistent with the ACA's removal of financial barriers, it is also possible that increases in CRC screening among lower socioeconomic groups may reflect the continuation of increasing secular trends that have been observed nationwide as well as in private health plans . In the previous 5‐year period (between 2003 and 2008), there was a significant increase in CRC screening among privately insured and Medicare‐insured individuals; however, the increase was universal across socioeconomic measures, including income and educational status.…”

Section: Discussionsupporting

confidence: 71%

“…Although our observations are consistent with the ACA's removal of financial barriers, it is also possible that increases in CRC screening among lower socioeconomic groups may reflect the continuation of increasing secular trends that have been observed nationwide as well as in private health plans. 10,11,22 In the previous 5-year period (between 2003 and 2008), there was a significant increase in CRC screening among privately insured and Medicare-insured individuals; however, the increase was universal across socioeconomic measures, including income and educational status. By contrast, the change in CRC screening between 2008 and 2013 was limited to subjects with lower income and lower levels of education (ie, the population subgroup that is expected to benefit the most from the ACA).…”

Section: Discussionmentioning

confidence: 99%

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Elimination of cost‐sharing and receipt of screening for colorectal and breast cancer

Fedewa

Goodman

Flanders

et al. 2015

Cancer

102

106

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BACKGROUND:The aim of the cost-sharing provision of the Patient Protection and Affordable Care Act (ACA) was to reduce financial barriers for preventive services, including screening for colorectal cancer (CRC) and breast cancer (BC) among privately and Medicare-insured individuals. Whether the provision has affected CRC and BC screening prevalence is unknown. The current study investigated whether CRC and BC screening prevalence among privately and Medicare-insured adults by socioeconomic status (SES) changed before and after the ACA. METHODS: Data obtained from the National Health Interview Survey pertaining to privately and Medicare-insured adults from 2008 (before the ACA) and 2013 (after the ACA) were used. There were 15,786 adults aged 50 to 75 years in the CRC screening analysis and 14,530 women aged 40 years in the BC screening analysis. Changes in guidelinerecommended screening between 2008 and 2013 by SES were expressed as the prevalence difference (PD) and 95% confidence interval (95% CI) adjusted for demographics, insurance, income, education, body mass index, and having a usual provider. RESULTS: Overall, CRC screening prevalence increased from 57.3% to 61.2% between 2008 and 2013 (P<.001). Adjusted CRC screening prevalence during the corresponding period increased in low-income (PD, 5.9; 95% CI, 1.8 to 10.2), least-educated (PD, 7.2; 95% CI, 0.9 to 13.5), and Medicare-insured (PD, 6.2; 95% CI, 1.7 to 10.7) individuals, but not in high-income, most-educated, and privately insured respondents. BC screening remained unchanged overall (70.5% in 2008 vs 70.2% in 2013) and in the low SES groups. CONCLUSIONS: Increases in CRC screening prevalence between 2008 and 2013 were confined to respondents with low SES. These findings may in part reflect the ACA's removal of financial barriers. Cancer 2015;121:3272-80.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Elimination of cost‐sharing and receipt of screening for colorectal and breast cancer

Fedewa

Goodman

Flanders

et al. 2015

Cancer

102

106

View full text Add to dashboard Cite

show abstract

“…In addition, there may have been a recall bias particularly related to self‐reporting of the timing of CRC screening. The non‐Hispanic multiracial/other group categorization was composed of heterogeneous racial and ethnic minorities groups, and this may have influenced results toward an association with increased CRC screening …”

Section: Discussionmentioning

confidence: 99%

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient‐provider communication

Lin

McKinley

Sripipatana

et al. 2017

Cancer

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The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017;123:4185-4192. © 2017 American Cancer Society.

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“…These discrepant findings could result from differences in sample size and composition as well as programmatic factors. 41 …”

Section: Discussionmentioning

confidence: 99%

Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program

Fedewa

Corley

Jensen

et al. 2017

American Journal of Preventive Medicine

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Introduction Recent studies report racial disparities among individuals in organized colorectal cancer (CRC) programs; however, there is a paucity of information on CRC screening utilization by race/ethnicity among newly age-eligible adults in such programs. Methods This was a retrospective cohort study among Kaiser Permanente Northern California enrollees who turned age 50 years between 2007 and 2012 (N=138,799) and were served by a systemwide outreach and facilitated in-reach screening program based primarily on mailed fecal immunochemical tests to screening-eligible people. Kaplan-Meier and Cox model analyses were used to estimate differences in receipt of CRC screening in 2015–2016. Results Cumulative probabilities of CRC screening within 1 and 2 years of subjects’ 50th birthday were 51% and 73%, respectively. Relative to non-Hispanic whites, the likelihood of completing any CRC screening was similar in blacks (hazard ratio, 0.98; 95% CI=0.96, 1.00), 5% lower in Hispanics (hazard ratio, 0.95; 95% CI=0.93, 0.96), and 13% higher in Asians (hazard ratio, 1.13; 95% CI=1.11, 1.15) in adjusted analyses. Fecal immunochemical testing was the most common screening modality, representing 86% of all screening initiations. Blacks and Hispanics had lower receipt of fecal immunochemical testing in adjusted analyses. Conclusions CRC screening uptake was high among newly screening-eligible adults in an organized CRC screening program, but Hispanics were less likely to initiate screening near age 50 years than non-Hispanic whites, suggesting that cultural and other individual-level barriers not addressed within the program likely contribute. Future studies examining the influences of culturally appropriate and targeted efforts for screening initiation are needed.

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Patterns of Colorectal Cancer Screening Uptake in Newly Eligible Men and Women

Cited by 25 publications

References 27 publications

Elimination of cost‐sharing and receipt of screening for colorectal and breast cancer

Elimination of cost‐sharing and receipt of screening for colorectal and breast cancer

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient‐provider communication

Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program

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