Volume 57, Issue 3 p. 412-418

Persistent Racial and Ethnic Disparities in Up-to-Date Colorectal Cancer Testing in Medicare Enrollees

Joshua J. Fenton MD, MPH

Joshua J. Fenton MD, MPH

From the Departments of * Family and Community Medicine Departments of Pediatrics, School of Medicine, Center for Health Research and Policy, University of California, Davis, Sacramento, California § Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington

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Daniel J. Tancredi PhD

Daniel J. Tancredi PhD

From the Departments of * Family and Community Medicine Departments of Pediatrics, School of Medicine, Center for Health Research and Policy, University of California, Davis, Sacramento, California § Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington

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Pamela Green PhD

Pamela Green PhD

From the Departments of * Family and Community Medicine Departments of Pediatrics, School of Medicine, Center for Health Research and Policy, University of California, Davis, Sacramento, California § Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington

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Peter Franks MD

Peter Franks MD

From the Departments of * Family and Community Medicine Departments of Pediatrics, School of Medicine, Center for Health Research and Policy, University of California, Davis, Sacramento, California § Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington

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Laura-Mae Baldwin MD, MPH

Laura-Mae Baldwin MD, MPH

From the Departments of * Family and Community Medicine Departments of Pediatrics, School of Medicine, Center for Health Research and Policy, University of California, Davis, Sacramento, California § Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington

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First published: 03 March 2009
Citations: 45
Address correspondence to Joshua Fenton, Department of Family and Community Medicine, University of California, Davis, 4860 Y Street, Suite 2300, Sacramento, CA 95817. E-mail: [email protected]

Abstract

OBJECTIVES: To assess whether greater colonoscopy use among white as compared with nonwhite Medicare enrollees since Medicare established coverage for colorectal cancer (CRC) screening has been associated with a widening in white versus nonwhite disparities in up-to-date CRC testing status.

DESIGN: Serial cross-sectional analysis of Medicare claims.

SETTING: Surveillance, Epidemiology, and End Results (SEER) regions in nine states, representing 14% of the U.S. population.

PARTICIPANTS: A 5% random sample of fee-for-service Medicare enrollees aged 70 to 79 within each 6-month period from mid-1995 through 2003.

MEASUREMENTS: Trends in up-to-date status (having a fecal occult blood test (FOBT) claim in the prior year or a sigmoidoscopy or colonoscopy claim in the prior 5 years) according to race or ethnicity, estimated using repeated-measures logistic regression adjusting for age, sex, rural versus urban residence, income, comorbidity, and SEER region.

RESULTS: From mid-1995 through 2003, the adjusted percentage of enrollees that were up-to-date increased by a similar magnitude in whites (from 39.4% to 47.3%), blacks (from 29.0% to 38.1%), Asians and Pacific Islanders (from 33.1% to 41.8%), and Hispanics (from 23.7% to 33.2%). Although white versus nonwhite disparities in up-to-date status via colonoscopy widened, this was counterbalanced by narrowing white versus nonwhite disparities in up-to-date status via FOBT and sigmoidoscopy.

CONCLUSION: White versus nonwhite disparities in up-to-date CRC testing status in Medicare enrollees largely persisted through 2003.