Trends in colonoscopy for colorectal cancer screening

Kathryn A. Phillips, Su Ying Liang, Uri Ladabaum, Jennifer Haas, Karla Kerlikowske, David Lieberman, Robert Hiatt, Mika Nagamine, Stephanie L. Van Bebber

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

BACKGROUND: A major health priority is to increase colorectal cancer screening, and colonoscopy has become an increasingly important method of screening. The Medicare program began coverage for colonoscopy for average risk individuals in 2001. OBJECTIVES: We sought to examine whether overall colorectal cancer screening increased over time and whether these increases were a result of increased utilization of all methods or a result of greater use of colonoscopy but reduced use of other methods, whether the enactment of Medicare coverage was associated with an increase in colonoscopy among Medicare enrollees, and whether these trends equally affected subpopulations. METHODS: We used nationally representative data from the 2000 and 2003 National Health Interview Surveys and analyzed data using used χ, difference-in-differences tests, and logistic regression analyses to examine whether screening rates differed between 2000 and 2003. RESULTS: The percentage of individuals being screened for colorectal cancer using any method increased modestly from 2000 to 2003 (3%), with increases a result of increased use of colonoscopy and a reduction in the use of other methods. Increases in colonoscopy use were significant among all populations except the insured, non-Medicare population with low incomes. Among Medicare enrollees with high/middle incomes, colonoscopy use increased 14% from 2000 to 2003 compared with an increase of only 7% among low-income groups, which was a significant difference (P <0.01). Similarly, among insured, non-Medicare enrollees with high/middle incomes, colonoscopy use increased 11% from 2000 to 2003 compared with an increase of only 4% among low-income groups, which also was a significant difference (P <0.01). CONCLUSIONS: Colorectal cancer screening utilization increased modestly from 2000 to 2003, with the increases that primarily were the result of increased colonoscopy use. Increases in colonoscopy use, however, were primarily among high/middle income groups. Although Medicare coverage may have indirectly facilitated the increase in colonoscopy, we could not determine that coverage directly increased screening rates. Screening rates remain modest and lower income individuals continue to be screened less. Topics for future research include approaches to facilitating screening among low-income individuals and evaluating the impact of policy coverage decisions.

Original languageEnglish (US)
Pages (from-to)160-167
Number of pages8
JournalMedical Care
Volume45
Issue number2
DOIs
StatePublished - Feb 2007

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Colonoscopy
Early Detection of Cancer
Colorectal Neoplasms
cancer
low income
coverage
trend
Medicare
income
utilization
Group
health
logistics
regression
Health Priorities
interview
Poverty
Health Surveys
Logistic Models
Regression Analysis

Keywords

  • Colorectal cancer screening utilization and trends
  • Disparities
  • Legislation
  • Medicare

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Phillips, K. A., Liang, S. Y., Ladabaum, U., Haas, J., Kerlikowske, K., Lieberman, D., ... Van Bebber, S. L. (2007). Trends in colonoscopy for colorectal cancer screening. Medical Care, 45(2), 160-167. https://doi.org/10.1097/01.mlr.0000246612.35245.21

Trends in colonoscopy for colorectal cancer screening. / Phillips, Kathryn A.; Liang, Su Ying; Ladabaum, Uri; Haas, Jennifer; Kerlikowske, Karla; Lieberman, David; Hiatt, Robert; Nagamine, Mika; Van Bebber, Stephanie L.

In: Medical Care, Vol. 45, No. 2, 02.2007, p. 160-167.

Research output: Contribution to journalArticle

Phillips, KA, Liang, SY, Ladabaum, U, Haas, J, Kerlikowske, K, Lieberman, D, Hiatt, R, Nagamine, M & Van Bebber, SL 2007, 'Trends in colonoscopy for colorectal cancer screening', Medical Care, vol. 45, no. 2, pp. 160-167. https://doi.org/10.1097/01.mlr.0000246612.35245.21
Phillips KA, Liang SY, Ladabaum U, Haas J, Kerlikowske K, Lieberman D et al. Trends in colonoscopy for colorectal cancer screening. Medical Care. 2007 Feb;45(2):160-167. https://doi.org/10.1097/01.mlr.0000246612.35245.21
Phillips, Kathryn A. ; Liang, Su Ying ; Ladabaum, Uri ; Haas, Jennifer ; Kerlikowske, Karla ; Lieberman, David ; Hiatt, Robert ; Nagamine, Mika ; Van Bebber, Stephanie L. / Trends in colonoscopy for colorectal cancer screening. In: Medical Care. 2007 ; Vol. 45, No. 2. pp. 160-167.
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abstract = "BACKGROUND: A major health priority is to increase colorectal cancer screening, and colonoscopy has become an increasingly important method of screening. The Medicare program began coverage for colonoscopy for average risk individuals in 2001. OBJECTIVES: We sought to examine whether overall colorectal cancer screening increased over time and whether these increases were a result of increased utilization of all methods or a result of greater use of colonoscopy but reduced use of other methods, whether the enactment of Medicare coverage was associated with an increase in colonoscopy among Medicare enrollees, and whether these trends equally affected subpopulations. METHODS: We used nationally representative data from the 2000 and 2003 National Health Interview Surveys and analyzed data using used χ, difference-in-differences tests, and logistic regression analyses to examine whether screening rates differed between 2000 and 2003. RESULTS: The percentage of individuals being screened for colorectal cancer using any method increased modestly from 2000 to 2003 (3{\%}), with increases a result of increased use of colonoscopy and a reduction in the use of other methods. Increases in colonoscopy use were significant among all populations except the insured, non-Medicare population with low incomes. Among Medicare enrollees with high/middle incomes, colonoscopy use increased 14{\%} from 2000 to 2003 compared with an increase of only 7{\%} among low-income groups, which was a significant difference (P <0.01). Similarly, among insured, non-Medicare enrollees with high/middle incomes, colonoscopy use increased 11{\%} from 2000 to 2003 compared with an increase of only 4{\%} among low-income groups, which also was a significant difference (P <0.01). CONCLUSIONS: Colorectal cancer screening utilization increased modestly from 2000 to 2003, with the increases that primarily were the result of increased colonoscopy use. Increases in colonoscopy use, however, were primarily among high/middle income groups. Although Medicare coverage may have indirectly facilitated the increase in colonoscopy, we could not determine that coverage directly increased screening rates. Screening rates remain modest and lower income individuals continue to be screened less. Topics for future research include approaches to facilitating screening among low-income individuals and evaluating the impact of policy coverage decisions.",
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N2 - BACKGROUND: A major health priority is to increase colorectal cancer screening, and colonoscopy has become an increasingly important method of screening. The Medicare program began coverage for colonoscopy for average risk individuals in 2001. OBJECTIVES: We sought to examine whether overall colorectal cancer screening increased over time and whether these increases were a result of increased utilization of all methods or a result of greater use of colonoscopy but reduced use of other methods, whether the enactment of Medicare coverage was associated with an increase in colonoscopy among Medicare enrollees, and whether these trends equally affected subpopulations. METHODS: We used nationally representative data from the 2000 and 2003 National Health Interview Surveys and analyzed data using used χ, difference-in-differences tests, and logistic regression analyses to examine whether screening rates differed between 2000 and 2003. RESULTS: The percentage of individuals being screened for colorectal cancer using any method increased modestly from 2000 to 2003 (3%), with increases a result of increased use of colonoscopy and a reduction in the use of other methods. Increases in colonoscopy use were significant among all populations except the insured, non-Medicare population with low incomes. Among Medicare enrollees with high/middle incomes, colonoscopy use increased 14% from 2000 to 2003 compared with an increase of only 7% among low-income groups, which was a significant difference (P <0.01). Similarly, among insured, non-Medicare enrollees with high/middle incomes, colonoscopy use increased 11% from 2000 to 2003 compared with an increase of only 4% among low-income groups, which also was a significant difference (P <0.01). CONCLUSIONS: Colorectal cancer screening utilization increased modestly from 2000 to 2003, with the increases that primarily were the result of increased colonoscopy use. Increases in colonoscopy use, however, were primarily among high/middle income groups. Although Medicare coverage may have indirectly facilitated the increase in colonoscopy, we could not determine that coverage directly increased screening rates. Screening rates remain modest and lower income individuals continue to be screened less. Topics for future research include approaches to facilitating screening among low-income individuals and evaluating the impact of policy coverage decisions.

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