title: Limited life expectancy among a subgroup of medicare beneficiaries receiving screening colonoscopies.
abstract: OBJECTIVE
  Life expectancy is an important consideration when assessing appropriateness of preventive programs for older individuals. Most studies on this subject have used age cutoffs as a proxy for life expectancy. We analyzed patterns of utilization of screening colonoscopy in Medicare enrollees by using estimated life expectancy.
  
  
  METHODS
  We used a 5% random national sample of Medicare claims data to identify average-risk patients who underwent screening colonoscopies from 2008 to 2010. Colonoscopies were considered to be screening colonoscopies in the absence of diagnoses for nonscreening indications, which were based on either colonoscopies or any claims in the preceding 3 months. We estimated life expectancies by using a model that combined age, sex, and comorbidity. Among patients who underwent screening colonoscopies, we calculated the percentage of those with life expectancies <10 years.
  
  
  RESULTS
  Among the 57,597 Medicare beneficiaries 66 years old or older who received at least 1 screening colonoscopy, 24.8% had an estimated life expectancy of <10 years. There was a significant positive association between total Medicare per capita costs in hospital referral regions and the proportion of patients with limited life expectancies (<10 years) at the time of screening colonoscopy (R = 0.25; P < .001, Pearson correlation test). In a multivariable analysis, men were substantially more likely than women to have limited life expectancy at the time of screening colonoscopy (odds ratio, 2.25; 95% confidence interval, 2.16-2.34).
  
  
  CONCLUSIONS
  Nearly 25% of Medicare beneficiaries, especially men, had life expectancies <10 years at the time of screening colonoscopies. Life expectancy should therefore be incorporated in decision-making for preventive services.
authors: Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas; Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Electronic address: smittal@bcm.edu.
authors: Sahil
authors: S
authors: Mittal
authors: Department of Medicine and Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas.
authors: Yu-Li
authors: YL
authors: Lin
authors: Department of Medicine and Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas.
authors: Alai
authors: A
authors: Tan
authors: Department of Medicine and Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas.
authors: Yong-Fang
authors: YF
authors: Kuo
authors: Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas; Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors: Hashem B
authors: HB
authors: El-Serag
authors: Department of Medicine and Sealy Center of Aging, University of Texas Medical Branch, Galveston, Texas.
authors: James S
authors: JS
authors: Goodwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D006278:Medicare; D014481:United States
keywords: Colon Cancer; Colonoscopy; Life Expectancy; Medicare
references: JAMA. 2012 Jan 11;307(2):199-200
references: 22235093
references: Arch Intern Med. 2011 Aug 8;171(15):1335-43
references: 21555653
references: JAMA. 2001 Jun 6;285(21):2750-6
references: 11386931
references: Gastroenterology. 2008 Oct;135(4):1100-5
references: 18691580
references: Int J Cancer. 1986 Aug 15;38(2):173-6
references: 3733258
references: Ann Intern Med. 2008 Nov 4;149(9):627-37
references: 18838716
references: Ann Intern Med. 1994 Jan 15;120(2):104-10
references: 8256968
references: Am J Public Health. 2004 Oct;94(10):1775-81
references: 15451749
references: JAMA Intern Med. 2013 Apr 8;173(7):526-31
references: 23478883
references: Cancer Epidemiol Biomarkers Prev. 2007 Oct;16(10):2118-27
references: 17932360
references: Am J Med. 1999 Jan 25;106(1A):3S-6S; discussion 50S-51S
references: 10089106
references: Med Care. 2011 Feb;49(2):225-30
references: 21150795
references: Gastroenterology. 1987 Nov;93(5):1009-13
references: 3653628
references: J Am Geriatr Soc. 2013 Mar;61(3):380-7
references: 23452077
references: Ann Intern Med. 2004 May 4;140(9):681-8
references: 15126251
references: JAMA. 2006 Nov 15;296(19):2336-42
references: 17105796
references: Ann Intern Med. 1993 Jan 1;118(1):63-8
references: 8416159
references: Gastroenterology. 2012 Sep;143(3):844-857
references: 22763141
references: BJU Int. 2007 Dec;100(6):1254-8
references: 17979925
references: Am J Gastroenterol. 2003 Sep;98(9):2082-91
references: 14499792
references: Am J Gastroenterol. 2003 Jul;98(7):1634-9
references: 12873591
references: JAMA. 2012 Jan 11;307(2):182-92
references: 22235089
references: Med Care. 2005 Nov;43(11):1130-9
references: 16224307
references: JAMA. 2006 May 24;295(20):2366-73
references: 16720822
references: Eur J Intern Med. 2009 Oct;20(6):640-4
references: 19782929
references: Gut. 2012 Nov;61(11):1576-82
references: 22200840
references: Gastroenterology. 2005 Oct;129(4):1163-70
references: 16230070
references: JAMA. 2004 Jan 7;291(1):71-8
references: 14709578
references: Cancer Detect Prev. 2004;28(4):260-8
references: 15350629
references: JAMA Intern Med. 2013 Apr 8;173(7):542-50
references: 23478992
references: N Engl J Med. 2010 Jul 1;363(1):45-53
references: 20463332
references: Evid Rep Technol Assess (Full Rep). 2010 Feb;(190):1-195, v
references: 20726624
references: Ann Intern Med. 2006 Nov 7;145(9):646-53
references: 17088577
references: Am J Gastroenterol. 2003 Aug;98(8):1875-80
references: 12907347
references: Ann Intern Med. 2009 Jun 16;150(12):849-57, W152
references: 19528563
references: Am J Epidemiol. 2013 Sep 15;178(6):974-83
references: 23851579
references: Am J Prev Med. 2012 Mar;42(3):229-34
references: 22341159