title: Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population.
abstract: Despite its demonstrated effectiveness, colorectal cancer (CRC) testing is suboptimal, particularly in vulnerable populations such as those who are publicly insured. Prior studies provide an incomplete picture of the importance of the intersection of multilevel factors affecting CRC testing across heterogeneous geographic regions where vulnerable populations live. We examined CRC testing across regions of North Carolina by using population-based Medicare and Medicaid claims data from disabled individuals who turned 50 years of age during 2003-2008. We estimated multilevel models to examine predictors of CRC testing, including distance to the nearest endoscopy facility, county-level endoscopy procedural rates, and demographic and community contextual factors. Less than 50% of eligible individuals had evidence of CRC testing; men, African-Americans, Medicaid beneficiaries, and those living furthest away from endoscopy facilities had significantly lower odds of CRC testing, with significant regional variation. These results can help prioritize intervention strategies to improve CRC testing among publicly insured, disabled populations.
authors: Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC 27599-7411, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, USA. Electronic address: stephanie_wheeler@unc.edu.
authors: Stephanie B
authors: SB
authors: Wheeler
authors: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA.
authors: Tzy-Mey
authors: TM
authors: Kuo
authors: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA.
authors: Ravi K
authors: RK
authors: Goyal
authors: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA.
authors: Anne-Marie
authors: AM
authors: Meyer
authors: Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC 27599-7411, USA.
authors: Kristen
authors: K
authors: Hassmiller Lich
authors: Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC 27599-7411, USA.
authors: Emily M
authors: EM
authors: Gillen
authors: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA.
authors: Seth
authors: S
authors: Tyree
authors: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, USA; Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 5045 Old Clinic Building, CB#7110, Chapel Hill, NC 27599-5039, USA.
authors: Carmen L
authors: CL
authors: Lewis
authors: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, USA.
authors: Trisha M
authors: TM
authors: Crutchfield
authors: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA.
authors: Christa E
authors: CE
authors: Martens
authors: Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
authors: Florence
authors: F
authors: Tangka
authors: Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
authors: Lisa C
authors: LC
authors: Richardson
authors: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, CB#7295, Chapel Hill, NC 27599-7295, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB#7426, Chapel Hill, NC 27599-7426, USA; Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 5045 Old Clinic Building, CB#7110, Chapel Hill, NC 27599-5039, USA.
authors: Michael P
authors: MP
authors: Pignone
mesh_terms: D001741:Black or African American; D000368:Aged; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000517:prevention & control; D006233:Persons with Disabilities; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D009657:North Carolina; D011203:Poverty; D012737:Sex Factors; D014481:United States
keywords: Colorectal cancer screening; Disabled; Medicaid; Medicare; Multilevel modeling; Regional variation