Predictors of endoscopic colorectal cancer screening over time in 11 states.
OBJECTIVE
We study a cohort of Medicare-insured men and women aged 65+ in the year 2000, who lived in 11 states covered by Surveillance, Epidemiology, and End Results (SEER) cancer registries, to better understand various predictors of endoscopic colorectal cancer (CRC) screening.


METHODS
We use multilevel probit regression on two cross-sectional periods (2000-2002, 2003-2005) and include people diagnosed with breast cancer, CRC, or inflammatory bowel disease (IBD) and a reference sample without cancer.


RESULTS
Men are not universally more likely to be screened than women, and African Americans, Native Americans, and Hispanics are not universally less likely to be screened than whites. Disparities decrease over time, suggesting that whites were first to take advantage of an expansion in Medicare benefits to cover endoscopic screening for CRC. Higher-risk persons had much higher utilization, while older persons and beneficiaries receiving financial assistance for Part B coverage had lower utilization and the gap widened over time.


CONCLUSIONS
Screening for CRC in our Medicare-insured sample was less than optimal, and reasons varied considerably across states. Negative managed care spillovers were observed, demonstrating that policy interventions to improve screening rates should reflect local market conditions as well as population diversity.
Mobley
Lee
L
RTI International, Durham, NC 27709-2194, USA. lmobley@rti.org
Kuo
Tzy-Mey
TM
Urato
Matthew
M
Boos
John
J
Lozano-Gracia
Nancy
N
Anselin
Luc
L
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology; D015331:Cohort Studies; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000208:ethnology; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D006278:Medicare; D011379:Prognosis; D012812:Sigmoidoscopy / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data