TY - JOUR
T1 - Predictors of endoscopic colorectal cancer screening over time in 11 states
AU - Mobley, Lee
AU - Kuo, Tzy Mey
AU - Urato, Matthew
AU - Boos, John
AU - Lozano-Gracia, Nancy
AU - Anselin, Luc
N1 - Funding Information:
Acknowledgments This work was supported by a National Cancer Institute grant (1R01CA126858-01A1). The content is solely the responsibility of the authors and does not necessarily represent the official views of RTI International, the National Cancer Institute, or the National Institutes of Health. Contextual data used in this paper are part of a larger public use database, the RTI Spatial Impact Factor Database. To obtain data, visit our Web site (http://rtispatialdata.rti.org), financed by American Recovery and Reinvestment Act supplemental funding for 1R01CA126858-01A1.
PY - 2010/3
Y1 - 2010/3
N2 - Objectives We study a cohort of Medicare-insured men and women aged 65+ in the year 2000, who lived in 11 states covered by Surveillance, Epidemiology, and End Results (SEER) cancer registries, to better understand various predictors of endoscopic colorectal cancer (CRC) screening. Methods We use multilevel probit regression on two cross-sectional periods (2000-2002, 2003-2005) and include people diagnosed with breast cancer, CRC, or inflammatory bowel disease (IBD) and a reference sample without cancer. Results Men are not universally more likely to be screened than women, and African Americans, Native Americans, and Hispanics are not universally less likely to be screened than whites. Disparities decrease over time, suggesting that whites were first to take advantage of an expansion in Medicare benefits to cover endoscopic screening for CRC. Higher-risk persons had much higher utilization, while older persons and beneficiaries receiving financial assistance for Part B coverage had lower utilization and the gap widened over time. Conclusions Screening for CRC in our Medicare-insured sample was less than optimal, and reasons varied considerably across states. Negative managed care spillovers were observed, demonstrating that policy interventions to improve screening rates should reflect local market conditions as well as population diversity.
AB - Objectives We study a cohort of Medicare-insured men and women aged 65+ in the year 2000, who lived in 11 states covered by Surveillance, Epidemiology, and End Results (SEER) cancer registries, to better understand various predictors of endoscopic colorectal cancer (CRC) screening. Methods We use multilevel probit regression on two cross-sectional periods (2000-2002, 2003-2005) and include people diagnosed with breast cancer, CRC, or inflammatory bowel disease (IBD) and a reference sample without cancer. Results Men are not universally more likely to be screened than women, and African Americans, Native Americans, and Hispanics are not universally less likely to be screened than whites. Disparities decrease over time, suggesting that whites were first to take advantage of an expansion in Medicare benefits to cover endoscopic screening for CRC. Higher-risk persons had much higher utilization, while older persons and beneficiaries receiving financial assistance for Part B coverage had lower utilization and the gap widened over time. Conclusions Screening for CRC in our Medicare-insured sample was less than optimal, and reasons varied considerably across states. Negative managed care spillovers were observed, demonstrating that policy interventions to improve screening rates should reflect local market conditions as well as population diversity.
KW - Colorectal cancer screening
KW - Managed care spillover
KW - Socio-ecological model
KW - Spatial heterogeneity
KW - Spatial interaction
KW - Utilization disparities
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U2 - 10.1007/s10552-009-9476-y
DO - 10.1007/s10552-009-9476-y
M3 - Article
C2 - 19946738
AN - SCOPUS:77950690852
SN - 0957-5243
VL - 21
SP - 445
EP - 461
JO - Cancer Causes and Control
JF - Cancer Causes and Control
IS - 3
ER -