Colorectal Cancer Screening Initiation Modalities Among Newly Age-Eligible Medicaid-Insured Individuals in Texas
Author(s)
Elham Heidari, MS, PharmD, PhD, Carolyn J. Brown, PhD, Karen Rascati, PhD, Kristin Richards, BS, MS, RPh, PhD, Jennifer Spencer, PhD;
University of Texas at Austin, Austin, TX, USA
University of Texas at Austin, Austin, TX, USA
OBJECTIVES: Previous research indicates that the landscape of utilized colorectal cancer (CRC) screening modalities is changing. This study describes rates of CRC screening initiation modalities among newly age-eligible Texas Medicaid beneficiaries and identifies its predictors.
METHODS: Medicaid beneficiaries who initiated CRC screening within 12 months of their age-eligible birthday (index date) between 2018 and 2021 were included if they were continuously enrolled 6 months before and 12 months after the index date. Those with dual Medicare eligibility or considered high risk for CRC (e.g., history of CRC, total colectomy, end-stage renal disease, cystic fibrosis, inflammatory bowel disease) were excluded. The study outcome was CRC screening modality (colonoscopy/fecal tests) and predictors included social drivers of health /community context (e.g., rural/urban, telehealth use, federally qualified health center use, endoscopy facility access) and demographic/clinical factors (e.g., guideline-concordant age, sex, race/ethnicity, index year, number of outpatient visits, comorbidity index score). Bivariate analyses and logistic regression were conducted.
RESULTS: Among the total of 1,722 Texas Medicaid beneficiaries who initiated CRC screening within the 12-month post-index period, 46.7% (N=804) underwent colonoscopy and 50.5% (N=869) used fecal tests, while the remaining 2.8% (N=49) underwent sigmoidoscopy. The odds of receiving a colonoscopy (compared to a fecal test) were 8% lower among 50-year-old Medicaid beneficiaries as compared with 45-year-old subjects (OR 0.92; 95% CI 0.88-0.97). Also, compared to Whites, the odds of receiving a colonoscopy were lower among ethnic and racial minorities including Blacks (OR 0.57; 95% CI 0.41-0.78), Hispanics (OR 0.70; 95% CI 0.53-0.91), as well as individuals of unknown race (OR 0.57; 95% CI 0.41-0.79). Those living in urban areas had lower odds of receiving a colonoscopy compared to rural residents (OR 0.53; 95%CI 0.41-0.70).
CONCLUSIONS: CRC screening initiation modalities were almost equally distributed between colonoscopy and fecal tests. Interventions can be better tailored to race/ethnicity and urban/rural status of individuals.
METHODS: Medicaid beneficiaries who initiated CRC screening within 12 months of their age-eligible birthday (index date) between 2018 and 2021 were included if they were continuously enrolled 6 months before and 12 months after the index date. Those with dual Medicare eligibility or considered high risk for CRC (e.g., history of CRC, total colectomy, end-stage renal disease, cystic fibrosis, inflammatory bowel disease) were excluded. The study outcome was CRC screening modality (colonoscopy/fecal tests) and predictors included social drivers of health /community context (e.g., rural/urban, telehealth use, federally qualified health center use, endoscopy facility access) and demographic/clinical factors (e.g., guideline-concordant age, sex, race/ethnicity, index year, number of outpatient visits, comorbidity index score). Bivariate analyses and logistic regression were conducted.
RESULTS: Among the total of 1,722 Texas Medicaid beneficiaries who initiated CRC screening within the 12-month post-index period, 46.7% (N=804) underwent colonoscopy and 50.5% (N=869) used fecal tests, while the remaining 2.8% (N=49) underwent sigmoidoscopy. The odds of receiving a colonoscopy (compared to a fecal test) were 8% lower among 50-year-old Medicaid beneficiaries as compared with 45-year-old subjects (OR 0.92; 95% CI 0.88-0.97). Also, compared to Whites, the odds of receiving a colonoscopy were lower among ethnic and racial minorities including Blacks (OR 0.57; 95% CI 0.41-0.78), Hispanics (OR 0.70; 95% CI 0.53-0.91), as well as individuals of unknown race (OR 0.57; 95% CI 0.41-0.79). Those living in urban areas had lower odds of receiving a colonoscopy compared to rural residents (OR 0.53; 95%CI 0.41-0.70).
CONCLUSIONS: CRC screening initiation modalities were almost equally distributed between colonoscopy and fecal tests. Interventions can be better tailored to race/ethnicity and urban/rural status of individuals.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD14
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology