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• W4384664209 abstract "Background: Approximately one-third of the eligible U.S. population have not undergone guideline-compliant colorectal cancer (CRC) screening. Guidelines recognize various screening strategies, to increase adherence. CMS provides coverage for all recommended screening tests except for CT colonography (CTC). Objective: To compare CTC and other CRC screening tests in terms of associations of utilization with income, race and ethnicity, and urbanicity, in Medicare fee-for-service beneficiaries. Methods: This retrospective study used CMS Research Identifiable Files from January 1, 2011, to December 31, 2020. These files contain claims information for 5% of Medicare fee-for-service beneficiaries. Data were extracted for individuals 45–85 years old, excluding those with high CRC risk. Multivariable logistic regression models were constructed to determine likelihood of undergoing CRC screening tests (as well as of undergoing diagnostic CTC, a CMS-covered test with similar physical access as screening CTC) as a function of income, race and ethnicity, and urbanicity, controlling for sex, age, Charlson comorbidity index, U.S. census region, screening year, and related conditions and procedures. Results: For 12,273,363 beneficiary years (mean age, 70.5±8.2 years; 6,774,837 female, 5,498,526 male; 2,436,849 unique beneficiaries), there were 785,103 CRC screenings events, including 645 for screening CTC. Compared with individuals living in communities with per capita income <$25,000, individuals in communities with income ≥$100,000 had OR for undergoing screening CTC of 5.73, optical colonoscopy of 1.36, sigmoidoscopy of 1.03, guaiac fecal-occult blood test/fecal immunochemical test of 1.50, stool DNA of 1.43, and diagnostic CTC of 2.00. Compared with non-Hispanic White individuals, OR for undergoing screening CTC was 1.00 for Hispanic individuals and 1.08 for non-Hispanic Black individuals. Compared with residents of metropolitan areas, OR for undergoing screening CTC was 0.51 for residents of micropolitan areas and 0.65 for residents of small or rural areas. Conclusion: The association with income was substantially larger for screening CTC than for other CRC screening tests or for diagnostic CTC. Clinical Impact: Medicare's non-coverage for screening CTC may contribute to lower adherence with screening guidelines for lower-income beneficiaries. Medicare coverage of CTC could reduce income-based disparities for individuals avoiding optical colonoscopy due to invasiveness, need for anesthesia, or complication risk." @default.
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• W4384664209 date "2023-07-19" @default.
• W4384664209 modified "2023-10-14" @default.
• W4384664209 title "Sociodemographic Factors and Screening CT Colonography Use Among Medicare Beneficiaries" @default.
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• W4384664209 doi "https://doi.org/10.2214/ajr.23.29703" @default.
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