Persistent racial and ethnic disparities in up-to-date colorectal cancer testing in medicare enrollees

Joshua J Fenton, Daniel J Tancredi, Pamela Green, Peter Franks, Laura Mae Baldwin

Research output: Contribution to journalArticlepeer-review

46 Scopus citations

Abstract

OBJECTIVES: To assess whether greater colonoscopy use among white as compared with nonwhite Medicare enrollees since Medicare established coverage for colorectal cancer (CRC) screening has been associated with a widening in white versus nonwhite disparities in up-to-date CRC testing status. DESIGN: Serial cross-sectional analysis of Medicare claims. SETTING: Surveillance, Epidemiology, and End Results (SEER) regions in nine states, representing 14% of the U.S. population. PARTICIPANTS: A 5% random sample of fee-for-service Medicare enrollees aged 70 to 79 within each 6-month period from mid-1995 through 2003. MEASUREMENTS: Trends in up-to-date status (having a fecal occult blood test (FOBT) claim in the prior year or a sigmoidoscopy or colonoscopy claim in the prior 5 years) according to race or ethnicity, estimated using repeated-measures logistic regression adjusting for age, sex, rural versus urban residence, income, comorbidity, and SEER region. RESULTS: From mid-1995 through 2003, the adjusted percentage of enrollees that were up-to-date increased by a similar magnitude in whites (from 39.4% to 47.3%), blacks (from 29.0% to 38.1%), Asians and Pacific Islanders (from 33.1% to 41.8%), and Hispanics (from 23.7% to 33.2%). Although white versus nonwhite disparities in up-to-date status via colonoscopy widened, this was counterbalanced by narrowing white versus nonwhite disparities in up-to-date status via FOBT and sigmoidoscopy. CONCLUSION: White versus nonwhite disparities in up-to-date CRC testing status in Medicare enrollees largely persisted through 2003.

Original languageEnglish (US)
Pages (from-to)412-418
Number of pages7
JournalJournal of the American Geriatrics Society
Volume57
Issue number3
DOIs
StatePublished - Mar 2009

Keywords

  • Colorectal neoplasms
  • Mass screening
  • Medicare/utilization

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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