Carcaise-Edinboro Patricia, Bradley Cathy J, Dahman Bassam
Department of Health Administration, Virginia Commonwealth University, Richmond, VA 23298, USA.
J Health Care Poor Underserved. 2009 Aug;20(3):854-65. doi: 10.1353/hpu.0.0172.
Cancer screening reduces late-stage diagnosis. Medicare and Medicaid dually eligible patients receive more late stage colorectal cancer (CRC) diagnoses.
Characteristics of CRC patients diagnosed between 1997 and 2000 were extracted from the Michigan Tumor Registry and Medicare administrative data, Area Resource File, and U.S. Census to assess CRC screening (fecal occult blood testing (FOBT), barium enema, colonoscopy, and sigmoidoscopy) and late stage CRC diagnosis.
Adjusted logistic regression models indicated dually eligible patients received less CRC screening (OR 0.68, 95% CI 0.59-0.78, p<.001). There was less late-stage diagnosis with colonoscopy receipt (OR 0.60, 95% CI 0.53-0.69, p<.001), sigmoidoscopy (OR 0.77, 95% CI 0.67-0.89, p<.001), and FOBT (OR 0.77, 95% CI 0.70-0.86, p<.01), but more if patients were dually eligible (OR 1.28, 95% CI=1.12-1.46, p<0.001).
Dually eligible CRC patients were screened less and diagnosed later than Medicare patients. Fecal occult blood testing remains a less invasive and less costly screening option that may reduce late-stage diagnosis in low income populations.
癌症筛查可减少晚期诊断。同时符合医疗保险和医疗补助条件的患者晚期结直肠癌（CRC）诊断更多。
从密歇根肿瘤登记处、医疗保险行政数据、区域资源文件和美国人口普查中提取1997年至2000年期间诊断的CRC患者的特征，以评估CRC筛查（粪便潜血试验（FOBT）、钡灌肠、结肠镜检查和乙状结肠镜检查）和晚期CRC诊断情况。
调整后的逻辑回归模型表明，双重资格患者接受的CRC筛查较少（比值比0.68，95%置信区间0.59 - 0.78，p <.001）。接受结肠镜检查（比值比0.60，95%置信区间0.53 - 0.69，p <.001）、乙状结肠镜检查（比值比0.77，95%置信区间0.67 - 0.89，p <.001）和FOBT（比值比0.77，95%置信区间0.70 - 0.86，p <.01）的患者晚期诊断较少，但双重资格患者的晚期诊断更多（比值比1.28，95%置信区间 = 1.12 - 1.46，p < 0.001）。
与医疗保险患者相比，双重资格的CRC患者筛查较少且诊断较晚。粪便潜血试验仍然是一种侵入性较小且成本较低的筛查选择，可能会减少低收入人群的晚期诊断。
