Colorectal Cancer Screening Initiation Among Newly Age-Eligible Medicaid-Insured Individuals in Texas
Author(s)
Elham Heidari, MS, PharmD, PhD, Carolyn Joyce 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: American Cancer Society 2018 guidelines for colorectal cancer (CRC) screening reduced the initial age of screening from 50 to 45. The objectives of this study were to describe rates of CRC screening initiation and determine its predictors using Texas Medicaid claims data.
METHODS: Medicaid beneficiaries who turned 45 or 50 between 2018 and 2021 were included in the study if they were continuously enrolled 6 months before and 12 months after their age-eligible birth date (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 primary study outcome was CRC screening initiation (yes/no) and independent variables included social drivers of health (SDoH)/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 41,207 included subjects, 52.7% (N=21,724) were 45 years of age and 68.0% (N=28,034) were female. Only 4.2% (N=1,722) received CRC screening within the first year following their age-eligible birthday. Patients aged 50 had 24% higher odds of initiating CRC screening as compared with those aged 45 (OR 1.24; 95% CI 1.21-1.28). Additionally, Hispanic individuals had 25% higher odds of initiating CRC screening as compared to White individuals (OR 1.25; 95% CI 1.09-1.43). Finally, individuals who turned age-eligible in 2020 had 28% lower odds of initiating CRC screening as compared with 2018 (OR 0.72; 95% CI 0.63-0.84).
CONCLUSIONS: This study identified a low rate of CRC screening initiation in the Texas Medicaid population. There is a need to develop interventions aimed to advance CRC screening initiation among age-eligible Medicaid beneficiaries.
METHODS: Medicaid beneficiaries who turned 45 or 50 between 2018 and 2021 were included in the study if they were continuously enrolled 6 months before and 12 months after their age-eligible birth date (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 primary study outcome was CRC screening initiation (yes/no) and independent variables included social drivers of health (SDoH)/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 41,207 included subjects, 52.7% (N=21,724) were 45 years of age and 68.0% (N=28,034) were female. Only 4.2% (N=1,722) received CRC screening within the first year following their age-eligible birthday. Patients aged 50 had 24% higher odds of initiating CRC screening as compared with those aged 45 (OR 1.24; 95% CI 1.21-1.28). Additionally, Hispanic individuals had 25% higher odds of initiating CRC screening as compared to White individuals (OR 1.25; 95% CI 1.09-1.43). Finally, individuals who turned age-eligible in 2020 had 28% lower odds of initiating CRC screening as compared with 2018 (OR 0.72; 95% CI 0.63-0.84).
CONCLUSIONS: This study identified a low rate of CRC screening initiation in the Texas Medicaid population. There is a need to develop interventions aimed to advance CRC screening initiation among age-eligible Medicaid beneficiaries.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD104
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology