Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population
Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population
复制标题
DOI：
10.1016/j.healthplace.2014.07.001
复制
发表时间：
2014-09-01
期刊：
影响因子：
4.8
通讯作者：
Pignone, Michael P.
中科院分区：
文献类型：
--
作者：
Wheeler, Stephanie B.;Kuo, Tzy-Mey;Pignone, Michael P.
尽管结直肠癌（CRC）检测已被证明是有效的，但它并不理想，特别是在弱势人群中，如那些有公共保险的人群。以前的研究提供了一个不完整的图片的多层次因素的交叉影响CRC测试跨异质地理区域的脆弱人群生活的重要性。我们通过使用2003-2008年期间年满50岁的残疾人的基于人口的医疗保险和医疗补助索赔数据，检查了北卡罗来纳州各地区的CRC测试。我们估计了多水平模型来检查CRC检测的预测因素，包括到最近的内窥镜检查设施的距离，县级内窥镜检查手术率以及人口统计学和社区背景因素。不到50%的合格个体有CRC检测的证据;男性，非洲裔美国人，医疗补助受益人和那些居住在离内窥镜检查设施最远的人的CRC检测几率显着降低，具有显着的区域差异。这些结果可以帮助优先考虑干预策略，以改善公共保险，残疾人群中的CRC检测。(C)2014爱思唯尔有限公司版权所有。
Despite its demonstrated effectiveness, colorectal cancer (CRC) testing is suboptimal, particularly in vulnerable populations such as those who are publicly insured. Prior studies provide an incomplete picture of the importance of the intersection of multilevel factors affecting CRC testing across heterogeneous geographic regions where vulnerable populations live. We examined CRC testing across regions of North Carolina by using population-based Medicare and Medicaid claims data from disabled individuals who turned 50 years of age during 2003-2008. We estimated multilevel models to examine predictors of CRC testing, including distance to the nearest endoscopy facility, county-level endoscopy procedural rates, and demographic and community contextual factors. Less than 50% of eligible individuals had evidence of CRC testing; men, African-Americans, Medicaid beneficiaries, and those living furthest away from endoscopy facilities had significantly lower odds of CRC testing, with significant regional variation. These results can help prioritize intervention strategies to improve CRC testing among publicly insured, disabled populations. (C) 2014 Elsevier Ltd. All rights reserved.