Phillips Kathryn A, Liang Su-Ying, Ladabaum Uri, Haas Jennifer, Kerlikowske Karla, Lieberman David, Hiatt Robert, Nagamine Mika, Van Bebber Stephanie L
University of California, San Francisco, CA 94143, USA.
Med Care. 2007 Feb;45(2):160-7. doi: 10.1097/01.mlr.0000246612.35245.21.
A major health priority is to increase colorectal cancer screening, and colonoscopy has become an increasingly important method of screening. The Medicare program began coverage for colonoscopy for average risk individuals in 2001.
We sought to examine whether overall colorectal cancer screening increased over time and whether these increases were a result of increased utilization of all methods or a result of greater use of colonoscopy but reduced use of other methods, whether the enactment of Medicare coverage was associated with an increase in colonoscopy among Medicare enrollees, and whether these trends equally affected subpopulations.
We used nationally representative data from the 2000 and 2003 National Health Interview Surveys and analyzed data using used chi, difference-in-differences tests, and logistic regression analyses to examine whether screening rates differed between 2000 and 2003.
The percentage of individuals being screened for colorectal cancer using any method increased modestly from 2000 to 2003 (3%), with increases a result of increased use of colonoscopy and a reduction in the use of other methods. Increases in colonoscopy use were significant among all populations except the insured, non-Medicare population with low incomes. Among Medicare enrollees with high/middle incomes, colonoscopy use increased 14% from 2000 to 2003 compared with an increase of only 7% among low-income groups, which was a significant difference (P < 0.01). Similarly, among insured, non-Medicare enrollees with high/middle incomes, colonoscopy use increased 11% from 2000 to 2003 compared with an increase of only 4% among low-income groups, which also was a significant difference (P < 0.01).
Colorectal cancer screening utilization increased modestly from 2000 to 2003, with the increases that primarily were the result of increased colonoscopy use. Increases in colonoscopy use, however, were primarily among high/middle income groups. Although Medicare coverage may have indirectly facilitated the increase in colonoscopy, we could not determine that coverage directly increased screening rates. Screening rates remain modest and lower income individuals continue to be screened less. Topics for future research include approaches to facilitating screening among low-income individuals and evaluating the impact of policy coverage decisions.
一项重要的健康优先事项是增加结直肠癌筛查，而结肠镜检查已成为一种越来越重要的筛查方法。医疗保险计划于2001年开始为平均风险个体提供结肠镜检查覆盖。
我们试图研究随着时间推移总体结直肠癌筛查是否增加，以及这些增加是由于所有方法的使用增加还是结肠镜检查使用增加但其他方法使用减少所致，医疗保险覆盖的实施是否与医疗保险参保者中结肠镜检查的增加相关，以及这些趋势是否同样影响亚人群。
我们使用了2000年和2003年全国健康访谈调查的全国代表性数据，并使用卡方检验、差异中的差异检验和逻辑回归分析来检查2000年和2003年筛查率是否不同。
从2000年到2003年，使用任何方法进行结直肠癌筛查的个体百分比适度增加（3%），增加是由于结肠镜检查使用增加和其他方法使用减少。除了有保险的低收入非医疗保险人群外，所有人群中结肠镜检查的使用都有显著增加。在高/中等收入的医疗保险参保者中，从2000年到2003年结肠镜检查的使用增加了14%，而低收入群体仅增加了7%，这是一个显著差异（P<0.01）。同样，在高/中等收入的有保险的非医疗保险参保者中，从2000年到2003年结肠镜检查的使用增加了11%，而低收入群体仅增加了4%，这也是一个显著差异（P<0.01）。
从2000年到2003年，结直肠癌筛查利用率适度增加，增加主要是由于结肠镜检查使用增加。然而，结肠镜检查使用的增加主要发生在高/中等收入群体中。虽然医疗保险覆盖可能间接促进了结肠镜检查的增加，但我们无法确定覆盖直接提高了筛查率。筛查率仍然适度，低收入个体的筛查率仍然较低。未来研究的主题包括促进低收入个体筛查的方法以及评估政策覆盖决策的影响。
