Racial and gender variation in use of diagnostic colonic procedures in the Michigan Medicare population.
BACKGROUND
There is accumulating evidence that screening programs can alter the natural history of colorectal cancer, a significant cause of mortality and morbidity in the US. Understanding how the technology to diagnose colonic diseases is utilized in the population provides insight into both the access and processes of care.


METHODS
Using Medicare Part B billing files from the state of Michigan from 1986 to 1989 we identified all procedures used to diagnose colorectal disease. We utilized the Medicare Beneficiary File and the Area Resource File to identify beneficiary-specific and community-sociodemographic characteristics. The beneficiary and sociodemographic characteristics were, then, used in multiple regression analyses to identify their association with procedure utilization.


RESULTS
Sigmoidoscopic use declined dramatically with the increasing age cohorts of Medicare beneficiaries. Urban areas and communities with higher education levels had more sigmoidoscopic use. Among procedures used to examine the entire colon, isolated barium enema was used more frequently in African Americans, the elderly, and females. The combination of barium enema and sigmoidoscopy was used more frequently among females and the newest technology, colonoscopy, was used most frequently among White males.


CONCLUSIONS
The existence of race, gender, and socioeconomic disparities in the use of colorectal technologies in a group of patients with near-universal insurance coverage demonstrates the necessity of understanding the reason(s) for these observed differences to improve access to appropriate technologies to all segments in our society.
McMahon
L F
LF
Department of Internal Medicine, the University of Michigan, Ann Arbor 48109-0376, USA. lmcmahon@umich.edu
Wolfe
R A
RA
Huang
S
S
Tedeschi
P
P
Manning
W
W
Edlund
M J
MJ
D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology*; D004733:Enema; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D016345:Medicare Part B / Q000706:statistics & numerical data*; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*
D001466:Barium Sulfate