Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50

Stephanie B. Wheeler, Tzy Mey Kuo, Anne Marie Meyer, Christa E. Martens, Kristen M. Hassmiller Lich, Florence K.L. Tangka, Lisa C. Richardson, Ingrid J. Hall, Judith Lee Smith, Maria E. Mayorga, Paul Brown, Trisha M. Crutchfield, Michael P. Pignone

Research output: Research - peer-reviewArticle

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Abstract

Understanding multilevel predictors of colorectal cancer (CRC) screening test modality can help inform screening program design and implementation. We used North Carolina Medicare, Medicaid, and private, commercially available, health plan insurance claims data from 2003 to 2008 to ascertain CRC test modality among people who received CRC screening around their 50th birthday, when guidelines recommend that screening should commence for normal risk individuals. We ascertained receipt of colonoscopy, fecal occult blood test (FOBT) and fecal immunochemical test (FIT) from billing codes. Person-level and county-level contextual variables were included in multilevel random intercepts models to understand predictors of CRC test modality, stratified by insurance type. Of 12,570 publicly-insured persons turning 50 during the study period who received CRC testing, 57% received colonoscopy, whereas 43% received FOBT/FIT, with significant regional variation. In multivariable models, females with public insurance had lower odds of colonoscopy than males (odds ratio [OR] = 0.68; p < 0.05). Of 56,151 privately-insured persons turning 50 years old who received CRC testing, 42% received colonoscopy, whereas 58% received FOBT/FIT, with significant regional variation. In multivariable models, females with private insurance had lower odds of colonoscopy than males (OR = 0.43; p < 0.05). People living 10–15 miles away from endoscopy facilities also had lower odds of colonoscopy than those living within 5 miles (OR = 0.91; p < 0.05). Both colonoscopy and FOBT/FIT are widely used in North Carolina among insured persons newly age-eligible for screening. The high level of FOBT/FIT use among privately insured persons and women suggests that renewed emphasis on FOBT/FIT as a viable screening alternative to colonoscopy may be important.

LanguageEnglish (US)
Pages9-16
Number of pages8
JournalPreventive Medicine Reports
Volume6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Colonoscopy
Colorectal Neoplasms
Occult Blood
Hematologic Tests
Insurance
Odds Ratio
Early Detection of Cancer
Medicaid
Health Insurance
Medicare
Endoscopy
Guidelines

Keywords

  • Cancer screening tests
  • Colonoscopy
  • Colorectal cancer
  • Fecal occult blood test
  • Medicaid
  • Medicare
  • Multilevel analysis

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health

Cite this

Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50. / Wheeler, Stephanie B.; Kuo, Tzy Mey; Meyer, Anne Marie; Martens, Christa E.; Hassmiller Lich, Kristen M.; Tangka, Florence K.L.; Richardson, Lisa C.; Hall, Ingrid J.; Smith, Judith Lee; Mayorga, Maria E.; Brown, Paul; Crutchfield, Trisha M.; Pignone, Michael P.

In: Preventive Medicine Reports, Vol. 6, 01.06.2017, p. 9-16.

Research output: Research - peer-reviewArticle

Wheeler, SB, Kuo, TM, Meyer, AM, Martens, CE, Hassmiller Lich, KM, Tangka, FKL, Richardson, LC, Hall, IJ, Smith, JL, Mayorga, ME, Brown, P, Crutchfield, TM & Pignone, MP 2017, 'Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50' Preventive Medicine Reports, vol 6, pp. 9-16. DOI: 10.1016/j.pmedr.2016.11.019
Wheeler, Stephanie B. ; Kuo, Tzy Mey ; Meyer, Anne Marie ; Martens, Christa E. ; Hassmiller Lich, Kristen M. ; Tangka, Florence K.L. ; Richardson, Lisa C. ; Hall, Ingrid J. ; Smith, Judith Lee ; Mayorga, Maria E. ; Brown, Paul ; Crutchfield, Trisha M. ; Pignone, Michael P./ Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50. In: Preventive Medicine Reports. 2017 ; Vol. 6. pp. 9-16
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