Effect of an equal-access military health system on racial disparities in colorectal cancer screening
Effect of an equal-access military health system on racial disparities in colorectal cancer screening
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DOI：
10.1002/cncr.31637
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发表时间：
2018-09-15
期刊：
影响因子：
6.2
通讯作者：
Goldberg, Joel E.
中科院分区：
文献类型：
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作者：
Changoor, Navin R.;Pak, Linda M.;Goldberg, Joel E.
背景：结直肠癌(CRC)筛查中的种族差异通常归因于保险状况的差异。这项研究的目的是确定与白人患者相比，全民保险是否会导致黑人患者更公平地利用结直肠癌筛查。方法：查询2007-2010年TRICARE(美国军队现役、预备役和退役军人及其家属的保险覆盖范围)的索赔数据，以50岁的成年人为对象，并对他们进行4年(年龄50-53岁)的追踪，以确定他们的第一次下内窥镜检查和/或粪便隐血试验(FOBT)。用描述性统计和多因素Logistic回归分析比较结直肠癌筛查的差异。结果：在24944名患者中，69.2%是白人，20.3%是黑人，4.9%是亚洲人，5.6%是其他人。总体而言，54.0%的人接受了任何筛查：83.7%的人接受了内窥镜检查，16.3%的人只接受了FOBT。与白人相比，黑人患者的筛查率更高(56.5%)，风险调整后的筛查几率高20%(95%可信区间[CI]，1.11-1.29)。亚裔患者进行筛查的可能性与白人患者相似(优势比[OR]为1.06；95%可信区间为0.92-1.23)。女性(OR，1.20；95%CI，1.10-1.33)、现役人员(OR，1.15；95%CI，1.06-1.25)和军官(OR，1.28；95%CI，1.18-1.37)也更有可能被筛查。结论：在人人平等的医疗保健体系中，黑人患者的结直肠癌筛查率高于以往的报道，甚至高于白人患者。这些调查结果突出表明，需要理解和制定有意义的办法，以促进更公平地获得预防性护理。此外，可以推定，为军人和平民提供平等、普遍的医疗保险可以改善服务不足的少数群体获得医疗保险的机会。(C)2018年美国癌症协会。
BACKGROUND: Racial disparities in colorectal cancer (CRC) screening are frequently attributed to variations in insurance status. The objective of this study was to ascertain whether universal insurance would lead to more equitable utilization of CRC screening for black patients in comparison with white patients. METHODS: Claims data from TRICARE (insurance coverage for active, reserve, and retired members of the US Armed Services and their dependents) for 2007-2010 were queried for adults aged 50 years in 2007, and they were followed forward in time for 4 years (ages, 50-53 years) to identify their first lower endoscopy and/or fecal occult blood test (FOBT). Variations in CRC screening were compared with descriptive statistics and multivariate logistic regression. RESULTS: Among the 24,944 patients studied, 69.2% were white, 20.3% were black, 4.9% were Asian, and 5.6% were other. Overall, 54.0% received any screening: 83.7% received endoscopy, and 16.3% received FOBT alone. Compared with whites, black patients had higher screening rates (56.5%) and had 20% higher risk-adjusted odds of being screened (95% confidence interval [CI], 1.11-1.29). Asian patients had a likelihood of screening similar to that of white patients (odds ratio [OR], 1.06; 95% CI, 0.92-1.23). Females (OR, 1.20; 95% CI, 1.10-1.33), active-duty personnel (OR, 1.15; 95% CI, 1.06-1.25), and officers (OR, 1.28; 95% CI, 1.18-1.37) were also more likely to be screened. CONCLUSION: Within an equal-access, universal health care system, black patients had higher rates of CRC screening in comparison with prior reports and even in comparison with white patients within the population. These findings highlight the need to understand and develop meaningful approaches for promoting more equitable access to preventative care. Moreover, equal-access, universal health insurance for both the military and civilian populations can be presumed to improve access for underserved minorities. (C) 2018 American Cancer Society.