Geographic and population-level disparities in colorectal cancer testing: A multilevel analysis of Medicaid and commercial claims data
Geographic and population-level disparities in colorectal cancer testing: A multilevel analysis of Medicaid and commercial claims data
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DOI：
10.1016/j.ypmed.2017.05.001
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发表时间：
2017-08-01
影响因子：
5.1
通讯作者：
Wheeler, Stephanie B.
中科院分区：
文献类型：
--
作者：
Davis, Melinda M.;Renfro, Stephanie;Wheeler, Stephanie B.
通过指南一致的筛查和干预可以降低结直肠癌（CRC）的发病率和死亡率。这项研究使用医疗补助和商业索赔数据来研究与一个州（俄勒冈州）CRC 检测率相关的个人和地理因素。在研究期间（2010 年 1 月至 2013 年 12 月），共有 64,711 名受益人（4516 名医疗补助受益人；60,195 名商业受益人）新达到了 CRC 筛查资格并符合纳入标准（例如，持续入组、无既往病史）。我们估计了多级模型来检查 CRC 检测的预测因素，包括个人（例如性别、保险、农村、获得护理的机会、到内窥镜设施的距离）和县级的地理因素（例如贫困、无保险）。尽管有保险，但在四年的研究窗口期间，只有五分之二 (42%) 的受益人有 CRC 检测的证据。俄勒冈州 36 个县的 CRC 检测率从 22.4% 到 46.8% 不等；社会经济贫困程度较高的县的检测水平较低。控制年龄后，如果受益人是女性（OR 1.04，95% CI 1.01-1.08）、商业保险或城市居民（OR 1.14，95% CI 1.07-1.21），则接受CRC检测的几率更大。获得初级保健（OR 2.47，95% CI 2.37-2.57）与检测相关，但与内窥镜检查的距离（OR 0.98，95% CI 0.92-1.03）无关。新符合年龄资格的医疗补助和商业会员的 CRC 检测率仍然明显较低。性别、居住地、保险范围和获得初级保健的机会存在差异。我们仍需努力将 CRC 检测提高到可接受的水平，并选择和实施针对最需要的县和人群的干预措施。 (C) 2017 Elsevier Inc. 保留所有权利。
Morbidity and mortality from colorectal cancer (CRC) can be attenuated through guideline concordant screening and intervention. This study used Medicaid and commercial claims data to examine individual and geographic factors associated with CRC testing rates in one state (Oregon). A total of 64,711 beneficiaries (4516 Medicaid; 60,195 Commercial) became newly age-eligible for CRC screening and met inclusion criteria (e. g., continuously enrolled, no prior history) during the study period (January 2010-December 2013). We estimated multilevel models to examine predictors for CRC testing, including individual (e.g., gender, insurance, rurality, access to care, distance to endoscopy facility) and geographic factors at the county level (e.g., poverty, uninsurance). Despite insurance coverage, only two out of five (42%) beneficiaries had evidence of CRC testing during the four year study window. CRC testing varied from 22.4% to 46.8% across Oregon's 36 counties; counties with higher levels of socioeconomic deprivation had lower levels of testing. After controlling for age, beneficiaries had greater odds of receiving CRC testing if theywere female (OR 1.04, 95% CI 1.01-1.08), commercially insured, or urban residents (OR 1.14, 95% CI 1.07-1.21). Accessing primary care (OR 2.47, 95% CI 2.37-2.57), but not distance to endoscopy (OR 0.98, 95% CI 0.92-1.03) was associated with testing. CRC testing in newly age-eligible Medicaid and commercial members remains markedly low. Disparities exist by gender, geographic residence, insurance coverage, and access to primary care. Work remains to increase CRC testing to acceptable levels, and to select and implement interventions targeting the counties and populations in greatest need. (C) 2017 Elsevier Inc. All rights reserved.