Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States; Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, United States; OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States.
Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States.
Prev Med. 2017 Aug;101:44-52. doi: 10.1016/j.ypmed.2017.05.001. Epub 2017 May 13.
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 they were 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.
结直肠癌（CRC）的发病率和死亡率可以通过符合指南的筛查和干预来降低。本研究利用医疗补助和商业索赔数据，研究了一个州（俄勒冈州）中与 CRC 检测率相关的个体和地理因素。在研究期间（2010 年 1 月至 2013 年 12 月），共有 64711 名受益人（4516 名医疗补助；60195 名商业）新达到 CRC 筛查的年龄要求，并符合纳入标准（例如，连续参保，无既往病史）。我们估计了多层次模型，以研究 CRC 检测的预测因素，包括个体因素（例如，性别、保险、农村、获得医疗服务的机会、距内镜设施的距离）和县级地理因素（例如，贫困、无保险）。尽管有保险，但在四年的研究窗口内，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检测率较低。在控制年龄后，如果受益人是女性（OR1.04，95%CI1.01-1.08）、商业保险或城市居民（OR1.14，95%CI1.07-1.21），则更有可能接受 CRC 检测。获得初级保健（OR2.47，95%CI2.37-2.57），而不是距内镜检查的距离（OR0.98，95%CI0.92-1.03）与检测相关。新符合年龄要求的医疗补助和商业成员的 CRC 检测率仍然明显较低。在性别、地理居住地、保险覆盖范围和获得初级保健方面存在差异。仍需要努力将 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。
