Is Travel Time to Colonoscopy Associated With Late-Stage Colorectal Cancer Among Medicare Beneficiaries in Iowa?
Is Travel Time to Colonoscopy Associated With Late-Stage Colorectal Cancer Among Medicare Beneficiaries in Iowa?
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DOI：
10.1111/jrh.12159
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发表时间：
2016-09-01
影响因子：
4.9
通讯作者：
Levy, Barcey T.
中科院分区：
文献类型：
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作者：
Charlton, Mary E.;Matthews, Kevin A.;Levy, Barcey T.
背景：结直肠癌(CRC)筛查可以降低晚期结直肠癌的发病率，但有相当大比例的美国人没有接受筛查。农村地区的人可能会因为旅行时间而面临结肠镜检查服务的障碍，之前的研究表明，农村居民的筛查水平较低。我们的目的是评估与晚期结直肠癌相关的因素，特别是确定在爱荷华州的参保人群中，较长的结肠镜检查时间是否与晚期结直肠癌相关。方法：使用SEER-Medicare数据来确定2002年至2009年爱荷华州65岁至84岁的被诊断为结直肠癌的患者。对于在诊断前连续3至4个月内有医疗保险服务费用并在此时间范围内进行结肠镜检查的专业索赔的每个人，计算居住地邮政编码与结肠镜检查邮政编码之间的距离。对早期和晚期结直肠癌患者的人口学特征和旅行时间进行比较。此外，在确诊前3-4个月内有结肠镜检查的患者(81%)与没有结肠镜检查的患者(19%)之间的人口统计学差异进行了比较。结果：共有5792名受试者符合纳入标准；31%的患者被诊断为早期结直肠癌，69%的患者为晚期结直肠癌。离异或丧偶(与已婚相比)更容易被诊断为晚期结直肠癌(OR：1.20，95%CI：1.06-1.37)。旅行时间与晚期大肠癌的诊断无关。讨论：在有医疗保险的人群中，接受结肠镜检查的旅行时间与确诊时的疾病阶段之间没有关系。在这一保险人群中，除了距离结肠镜检查的距离之外，其他因素很可能对筛查构成了更相关的障碍。考虑到这些参保个人中超过三分之二被诊断为晚期结直肠癌，应该进行进一步的研究，以确定那些能够获得结直肠癌筛查服务的人不遵守筛查的原因。
Background: Colorectal cancer (CRC) screening has been shown to decrease the incidence of late-stage colorectal cancer, yet a substantial proportion of Americans do not receive screening. Those in rural areas may face barriers to colonoscopy services based on travel time, and previous studies have demonstrated lower screening among rural residents. Our purpose was to assess factors associated with late-stage CRC, and specifically to determine if longer travel time to colonoscopy was associated with late-stage CRC among an insured population in Iowa.Methods: SEER-Medicare data were used to identify individuals ages 65 to 84 years old diagnosed with CRC in Iowa from 2002 to 2009. The distance between the centroid of the ZIP code of residence and the ZIP code of colonoscopy was computed for each individual who had continuous Medicare fee-for-service coverage for a 3- to 4-month period prior to diagnosis, and a professional claim for colonoscopy within that time frame. Demographic characteristics and travel times were compared between those diagnosed with early-versus late-stage CRC. Also, demographic differences between those who had colonoscopy claims identified within 3-4 months prior to diagnosis (81%) were compared to patients with no colonoscopy claims identified (19%).Results: A total of 5,792 subjects met inclusion criteria; 31% were diagnosed with early-stage versus 69% with late-stage CRC. Those divorced or widowed (vs married) were more likely to be diagnosed with late-stage CRC (OR: 1.20, 95% CI: 1.06-1.37). Travel time was not associated with diagnosis of late-stage CRC.Discussion: Among a Medicare-insured population, there was no relationship between travel time to colonoscopy and disease stage at diagnosis. It is likely that factors other than distance to colonoscopy present more pertinent barriers to screening in this insured population. Additional research should be done to determine reasons for nonadherence to screening among those with access to CRC screening services, given that over two-thirds of these insured individuals were diagnosed with late-stage CRC.