Abstract
Background: Medicare expanded coverage of colorectal cancer (CRC) screening in 2001 to include reimbursement for screening colonoscopy. The objective of this report was to examine trends and factors associated with CRC screening among non-institutionalized Medicare beneficiaries aged 65–80 years from 2000–2005.
Methods: We used data from the Medicare Current Beneficiary Surveys for 2000, 2003 and 2005 linked to Medicare claims data. The primary outcome for this study was the proportion who were up-to-date for CRC screening, defined as undergoing home fecal occult blood testing (FOBT) within one year and/or colonoscopy within five years of the interview date. We used the Chi-square test for trend to assess changes over the six-year period under study and examined predictors of screening using multivariable logistic regression models.
Results: The characteristics of the participants were similar for all three study-years. For 2000, median age was 73 years; 57% were female; 81% were whites, 9% were blacks, 7% were Hispanics, and 4% other ethnicities; 37% had income >$25,000; and 33% had 8th grade or less education, 35% up to high school graduation and 31% were educated beyond high school. During the study period, there was a statistically significant increase in the proportion of beneficiaries undergoing CRC screening from 44% to 51%. FOBT rates decreased from 18% to14% while colonoscopies increased from 36% to 57%. These changes were all statistically significant. For each of the three interview-years, enrollees were less likely to have been screened if they had not heard about CRC screening, did not know that Medicare provided reimbursement, a physician did not recommend testing, were lower income, less educated populations and experienced difficulty in receiving healthcare.
Conclusions: CRC screening among Medicare beneficiaries increased significantly from 2000 to 2005, following the introduction of expanded coverage. This increase occurred in tandem with increasing use of colonoscopy among beneficiaries. However, efforts are still needed to increase the reach of CRC to disadvantaged populations.
- Received September 11, 2008.
