title: Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years.
abstract: There are concerns about potential overuse of colorectal cancer (CRC) screening services among average-risk individuals older than age 75 years.
  
  
  
  Using a 5% random noncancer sample of Medicare beneficiaries who resided in the SEER areas, we examined rates of CRC screening adherence, defined by the Medicare coverage policy, among average-risk fee-for-service beneficiaries age 76 to 95 years from 2002 to 2010. The two outcomes are the status of overall CRC screening adherence, and the status of adherence to colonoscopy (v other modalities) conditional on patient adherence.
  
  
  
  Overall CRC screening adherence rates of Medicare beneficiaries age 76 to 95 years increased from 13.0% to 21.4% from 2002 to 2010. In 2002, 2.2% of beneficiaries were adherent to colonoscopy, and 10.7%, by other modalities; the corresponding rates were 19.5% and 1.9%, respectively, in 2010. Specifically, rates of adherence to colonoscopy were 1.1% for those age 86 to 90 years and almost nil for those age 91 to 95 years in 2002, but the rates became 13.5% and 8.2%, respectively, in 2010. Compared with white beneficiaries, black beneficiaries age 76 to 95 years had a 7-percentage-point lower adherence rate. However, overall adherence rates among blacks increased by 168.6% from 2002 to 2010, whereas rates among whites increased by 63.0%. Logistic regressions showed that blacks age 86 to 95 years were less likely than whites to be adherent (odds ratio, 0.56; 95% CI, 0.47 to 0.59) but were more likely to be adherent to colonoscopy (odds ratio, 2.34; 95% CI, 1.47 to 3.91).
  
  
  
  High proportions of average-risk Medicare fee-for-service beneficiaries screened by colonoscopy may represent opportunities for improving appropriateness and allocative efficiency of CRC screening by Medicare.
authors.affiliation: South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China jbian@sccp.sc.edu.
authors.forename: John
authors.initials: J
authors.lastname: Bian
authors.affiliation: South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Charles
authors.initials: C
authors.lastname: Bennett
authors.affiliation: South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Gregory
authors.initials: G
authors.lastname: Cooper
authors.affiliation: South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Alessandra
authors.initials: A
authors.lastname: D'Alfonso
authors.affiliation: South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Deborah
authors.initials: D
authors.lastname: Fisher
authors.affiliation: South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Chao-Nan
authors.initials: CN
authors.lastname: Qian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D014481:United States