RESEARCH ARTICLE
Initiation of Colorectal Cancer Screening Among Medicaid Enrollees

https://doi.org/10.1016/j.amepre.2019.09.015Get rights and content

Introduction

Few studies have explored how individual- and practice-level factors influence colorectal cancer screening initiation among Medicaid enrollees newly age eligible for colorectal cancer screening (i.e., turning 50 years). This study explored colorectal cancer screening initiation among newly age-eligible Medicaid enrollees in Oregon.

Methods

Medicaid claims data (January 2013 to June 2015) were used to conduct multivariable logistic regression (in 2018 and 2019) to explore individual- and practice-level factors associated with colorectal cancer screening initiation among 9,032 Medicaid enrollees.

Results

A total of 17% of Medicaid enrollees initiated colorectal cancer screening; of these, 64% received a colonoscopy (versus fecal testing). Colorectal cancer screening initiation was positively associated with turning 50 years in 2014 (versus 2013; OR=1.21), being Hispanic (versus non-Hispanic white; OR=1.41), urban residence (versus rural; OR=1.23), and having 4 to 7 (OR=1.90) and 8 or more (OR=2.64) primary care visits compared with 1 to 3 visits in the year after turning 50 years. Having 3 or more comorbidities was inversely associated with initiation (OR=0.75). The odds of screening initiation were also higher for practices with 3 to 4 (OR=1.26) and 8 or more (OR=1.34) providers compared with 1 to 2 providers, and negatively associated with percentage of Medicaid panel age eligible for colorectal cancer screening (OR=0.92).

Conclusions

Both individual- and practice-level factors are associated with disparities in colorectal cancer screening initiation among Oregon Medicaid enrollees. Future work promoting colorectal cancer screening might focus on additional barriers to the timely initiation of colorectal cancer screening and explore the effect of practice in-reach and population outreach strategies.

Section snippets

INTRODUCTION

Colorectal cancer (CRC) is the second most common cause of cancer death in the U.S.1,2 The U.S. Preventive Services Task Force recommends that screening for CRC begin at age 50 years for average-risk adults and endorses high-sensitivity fecal occult blood testing (FOBT) every year, sigmoidoscopy every 5 years, or colonoscopy every 10 years.3 Despite the availability of effective screening tools, screening for CRC remains widely underutilized.4 National data suggest that only 60% of publicly

METHODS

Timely and reliable Medicaid enrollment and claims data (January 2013 to June 2015) were obtained from the Oregon Health Authority20 under a data use agreement with the Oregon Health & Science University. The data included monthly enrollment numbers, demographic information, and claims data for enrollees with healthcare encounters. The IRBs at Oregon State University and the Oregon Health & Science University approved the study.

RESULTS

Table 1 provides descriptive statistics for the 9,032 study-eligible Medicaid enrollees who turned age 50 years in 2013 (51%) and 2014 (49%). Sixty-nine percent of enrollees self-identified as non-Hispanic white; 13% self-identified as Hispanic, and 18% were an other race/ethnicity. More than half (57%) of the enrollees lived in an urban area, and 53% had more than one comorbidity. Enrollees had a mean of 5 primary care visits, and 75% had at least 1 primary care visit in the year after turning

DISCUSSION

Among newly age-eligible Medicaid enrollees in Oregon, 17% initiated CRC screening, that is, received any CRC screening in the first year after turning 50 years; of these, 64% received a colonoscopy, which is consistent with the previous research of publicly insured adults.15,32,33 A CRC screening initiation was associated with race/ethnicity, residence, comorbidities, primary care visits, number of providers, and percentage of Medicaid panel aged eligible for CRC screening. The finding that

CONCLUSIONS

Among this newly age-eligible Medicaid population, only 17% of Medicaid enrollees initiated CRC screening, that is, received any CRC screening in the year after turning 50 years. However, during the past decade, Oregon has been actively involved in efforts to increase CRC screening. Compared with 2010, Oregon has experienced a significant increase in CRC screening among newly age-eligible individuals who enrolled in Medicaid during 2013 and 2014.17 In 2012, Oregon transformed its healthcare

ACKNOWLEDGMENTS

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Knight Cancer Institute or NIH. Neither of the study sponsors had any role in the study design, data collection, data analysis, interpretation of findings, writing of the manuscript, or in the decision to submit this manuscript for publication.

The study was supported by the Knight Cancer Institute-Oregon Health & Sciences University/Oregon State University Cancer Prevention and

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