Persistent Racial and Ethnic Disparities in Up-to-Date Colorectal Cancer Testing in Medicare Enrollees
Persistent Racial and Ethnic Disparities in Up-to-Date Colorectal Cancer Testing in Medicare Enrollees
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DOI：
10.1111/j.1532-5415.2008.02143.x
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发表时间：
2009-03-01
影响因子：
6.3
通讯作者：
Baldwin, Laura-Mae
中科院分区：
文献类型：
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作者：
Fenton, Joshua J.;Tancredi, Daniel J.;Baldwin, Laura-Mae
为了评估自从医疗保险建立结直肠癌（CRC）筛查覆盖范围以来，与非白色医疗保险登记者相比，白色人使用更多结肠镜检查是否与白色人与非白色人在最新CRC检测状态方面的差异扩大有关。从1995年中期到2003年，每6个月内随机抽取5%的70至79岁的按服务收费的医疗保险登记者。（前一年有粪便潜血试验（FOBT）要求或前5年有乙状结肠镜检查或结肠镜检查要求），使用重复测量逻辑回归进行估计，调整年龄、性别、农村与城市居住地、收入、合并症和SEER地区。从1995年中期到2003年，在白人中，调整后的最新注册者百分比增加了类似的幅度（从39.4%到47.3%）、黑人（从29.0%到38.1%）、亚洲人和太平洋岛民（从33.1%到41.8%）和西班牙裔（从23.7%到33.2%）。虽然白色与非白色在结肠镜检查中的最新状态差异扩大，但通过FOBT和乙状结肠镜检查缩小白色与非白色在最新状态中的差异可以抵消这一差异。白色与非白色在Medicare登记者中的最新CRC检测状态的差异在很大程度上持续到2003年。
To assess whether greater colonoscopy use among white as compared with nonwhite Medicare enrollees since Medicare established coverage for colorectal cancer (CRC) screening has been associated with a widening in white versus nonwhite disparities in up-to-date CRC testing status.Serial cross-sectional analysis of Medicare claims.Surveillance, Epidemiology, and End Results (SEER) regions in nine states, representing 14% of the U.S. population.A 5% random sample of fee-for-service Medicare enrollees aged 70 to 79 within each 6-month period from mid-1995 through 2003.Trends in up-to-date status (having a fecal occult blood test (FOBT) claim in the prior year or a sigmoidoscopy or colonoscopy claim in the prior 5 years) according to race or ethnicity, estimated using repeated-measures logistic regression adjusting for age, sex, rural versus urban residence, income, comorbidity, and SEER region.From mid-1995 through 2003, the adjusted percentage of enrollees that were up-to-date increased by a similar magnitude in whites (from 39.4% to 47.3%), blacks (from 29.0% to 38.1%), Asians and Pacific Islanders (from 33.1% to 41.8%), and Hispanics (from 23.7% to 33.2%). Although white versus nonwhite disparities in up-to-date status via colonoscopy widened, this was counterbalanced by narrowing white versus nonwhite disparities in up-to-date status via FOBT and sigmoidoscopy.White versus nonwhite disparities in up-to-date CRC testing status in Medicare enrollees largely persisted through 2003.