CRC Screening Disparities Persist for Seniors on Medicare

Those without usual place of health care are the least likely to undergo colorectal cancer screening
By Jeff Muise
HealthDay Reporter

TUESDAY, July 20 (HealthDay News) -- Despite expanding coverage for colorectal cancer (CRC) screening in the Medicare population, disparities persist based on differences in usual place of health care, education level, and insurance coverage type, according to research published in the July/August issue of the Annals of Family Medicine.

Chyke A. Doubeni, M.D., of the University of Massachusetts Medical School in Worcester, and colleagues analyzed Medicare data for screening in seniors (aged 65 to 80) without renal disease or CRC for the years 2000, 2003, and 2005. The researchers assessed utilization of endoscopy (colonoscopy/sigmoidoscopy) within the past five years, endoscopy more than five years previously, and fecal occult blood test (FOBT) within the past two years.

The investigators found that subjects who had no usual source for their health care were the least likely to receive screening, and this gap worsened over the study period. In that group, in 2000, the adjusted odds ratio was 0.27 for FOBT and 0.35 for recent endoscopy; in 2005, the adjusted odds ratio was 0.18 for FOBT and 0.22 for endoscopy. Disparities in recent endoscopy use by health insurance coverage type were larger for those with a high school education or higher than for those with less education in both 2000 and 2005.

"Outreach programs that include efforts to encourage enrollees to have regular visits with a primary care physician and to undergo an annual preventive health examination, as well as reminder systems for patients and primary care physicians to consider all screening options carefully, including FOBT, may further increase CRC screening rates and mitigate disparities for vulnerable populations," the authors write.

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