不同医保类型的结直肠癌筛查后随访时间。

Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type.

机构信息

Office of Science Planning, Policy, Analysis, Reporting and Data, National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland.

Department of Clinical Sciences, Parkland Health and Hospital System/University of Texas Southwestern Medical Center, Dallas, Texas; Department of Population Sciences, Simmons Comprehensive Cancer Center, Dallas, Texas.

出版信息

Am J Prev Med. 2019 May;56(5):e143-e152. doi: 10.1016/j.amepre.2019.01.005.

DOI:10.1016/j.amepre.2019.01.005

PMID:31003603

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6820676/

Abstract

INTRODUCTION

The purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same healthcare systems.

METHODS

A total of 35,009 patients aged 50-64years with a positive fecal immunochemical test were evaluated in Northern and Southern California Kaiser Permanente systems and in a North Texas safety-net system between 2011 and 2012. Kaplan-Meier estimation was used between 2016 and 2017 to calculate the probability of having follow-up colonoscopy by coverage type. Among Kaiser Permanente patients, Cox regression was used to estimate hazard ratios and 95% CIs for the association between coverage type and receipt of follow-up, adjusting for sociodemographics and health status.

RESULTS

Even within the same integrated system with organized follow-up, patients with Medicaid were 24% less likely to complete follow-up as those with commercial insurance. Percentage receiving colonoscopy within 3 months after a positive fecal immunochemical test was 74.6% for commercial insurance, 63.10% for Medicaid only, and 37.5% for patients served by the integrated safety-net system.

CONCLUSIONS

This study found that patients with Medicaid were less likely than those with commercial insurance to complete follow-up colonoscopy after a positive fecal immunochemical test and had longer average times to follow-up. With the future of coverage mechanisms uncertain, it is important and timely to assess influences of health insurance coverage on likelihood of follow-up colonoscopy and identify potential disparities in screening completion.

摘要

简介

本研究旨在检验如下假设，即在同一医疗体系中，与拥有商业保险的患者相比，拥有医疗补助保险或类似医疗补助保险覆盖的患者进行结肠镜检查的随访时间更长，且更不可能完成结肠镜检查。

方法

2011 年至 2012 年，在加利福尼亚州北部和南部的 Kaiser Permanente 系统以及德克萨斯州北部的一个医疗保障安全网系统中，对 35009 名年龄在 50-64 岁之间、粪便免疫化学检测呈阳性的患者进行了评估。2016 年至 2017 年，使用 Kaplan-Meier 估计来计算不同保险类型的患者接受随访结肠镜检查的概率。在 Kaiser Permanente 的患者中，使用 Cox 回归来估计保险类型与接受随访之间的关联的风险比和 95%置信区间，同时调整社会人口统计学和健康状况因素。