title: Screening colonoscopy among colorectal cancer survivors insured by Medicaid.
abstract: OBJECTIVE
  The objectives of this research study are to describe the proportion of Medicaid-insured colorectal cancer survivors who had a colonoscopy between 3 and 18 months after surgery of the colon or rectum and to determine if patient, health services, and community characteristics are associated with colonoscopy follow-up after treatment.
  
  
  METHODS
  A retrospective cohort study among 1044 Medicaid-insured individuals diagnosed with local or regional colorectal cancer was conducted. Multivariable logistic regression analyses assessed patient, hospital, and community characteristics associated with colonoscopy.
  
  
  RESULTS
  About 42% of the study population had a colonoscopy 3 to 18 months after surgery. Factors associated with receipt of colonoscopy in the multivariable model include having colon (vs rectal) cancer, having local (vs regional) cancer, and having received chemotherapy as part of first course of therapy. Being 75 or older (vs <65), having first course of therapy at a hospital with the highest surgical volume (vs lowest surgical volume), and living in an urban (vs rural) environment were associated with a decreased likelihood of colonoscopy. Colonoscopy utilization patterns diverge after 65 years of age when persons become dually insured by Medicare. By age 80 years, there seems to be an almost 3-fold difference in receipt of colonoscopy-those with comorbidity are more likely to be screened than those without comorbidity.
  
  
  CONCLUSIONS
  Less than half of Medicaid-insured colorectal cancer survivors received a colonoscopy in 3 to 18 months after colorectal resection. Improvements in screening in this high-risk population should be the target of future interventions to reduce the probability of recurrence.
authors.affiliation: Medical Humanities Program, Davidson College, Davidson, NC, USA. krfoley@davidson.edu
authors.forename: Kristie Long
authors.initials: KL
authors.lastname: Foley
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Song
authors.forename: Heidi
authors.initials: H
authors.lastname: Klepin
authors.forename: Ann
authors.initials: A
authors.lastname: Geiger
authors.forename: Janet
authors.initials: J
authors.lastname: Tooze
mesh_terms: D000367:Age Factors; D000368:Aged; D003113:Colonoscopy / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008484:Medicaid / Q000191:economics*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D014481:United States