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


METHODS
Serial cross-sectional analysis of Medicare claims.


METHODS
Surveillance, Epidemiology, and End Results (SEER) regions in nine states, representing 14% of the U.S. population.


METHODS
A 5% random sample of fee-for-service Medicare enrollees aged 70 to 79 within each 6-month period from mid-1995 through 2003.


METHODS
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.


CONCLUSIONS
White versus nonwhite disparities in up-to-date CRC testing status in Medicare enrollees largely persisted through 2003.
Fenton
Joshua J
JJ
Department of Family and Community Medicine, School of Medicine, University of California, Davis, Sacramento, California 95817, USA. Joshua.fenton@ucdmc.ucdavis.edu
Tancredi
Daniel J
DJ
Green
Pamela
P
Franks
Peter
P
Baldwin
Laura-Mae
LM
D000368:Aged; D001213:Asian / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D009780:Occult Blood; D012424:Rural Population / Q000706:statistics & numerical data; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American