Is Travel Time to Colonoscopy Associated With Late‐Stage Colorectal Cancer Among Medicare Beneficiaries in Iowa?

Journal of Rural Health - Tập 32 Số 4 - Trang 363-373 - 2016
Mary E. Charlton1, Karen A. Matthews2, Anne H. Gaglioti3, Camden P. Bay1,3, Bradley D. McDowell4, Marcia M. Ward5, Barcey T. Levy1,3
1Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
2Department of Geography, University of Iowa, Iowa City, Iowa
3Department of Family Medicine, University of Iowa, Carver College of Medicine, Iowa City, Iowa
4Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
5Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa

Tóm tắt

AbstractBackgroundColorectal cancer (CRC) screening has been shown to decrease the incidence of late‐stage colorectal cancer, yet a substantial proportion of Americans do not receive screening. Those in rural areas may face barriers to colonoscopy services based on travel time, and previous studies have demonstrated lower screening among rural residents. Our purpose was to assess factors associated with late‐stage CRC, and specifically to determine if longer travel time to colonoscopy was associated with late‐stage CRC among an insured population in Iowa.MethodsSEER‐Medicare data were used to identify individuals ages 65 to 84 years old diagnosed with CRC in Iowa from 2002 to 2009. The distance between the centroid of the ZIP code of residence and the ZIP code of colonoscopy was computed for each individual who had continuous Medicare fee‐for‐service coverage for a 3‐ to 4‐month period prior to diagnosis, and a professional claim for colonoscopy within that time frame. Demographic characteristics and travel times were compared between those diagnosed with early‐ versus late‐stage CRC. Also, demographic differences between those who had colonoscopy claims identified within 3‐4 months prior to diagnosis (81%) were compared to patients with no colonoscopy claims identified (19%).ResultsA total of 5,792 subjects met inclusion criteria; 31% were diagnosed with early‐stage versus 69% with late‐stage CRC. Those divorced or widowed (vs married) were more likely to be diagnosed with late‐stage CRC (OR: 1.20, 95% CI: 1.06‐1.37). Travel time was not associated with diagnosis of late‐stage CRC.DiscussionAmong a Medicare‐insured population, there was no relationship between travel time to colonoscopy and disease stage at diagnosis. It is likely that factors other than distance to colonoscopy present more pertinent barriers to screening in this insured population. Additional research should be done to determine reasons for nonadherence to screening among those with access to CRC screening services, given that over two‐thirds of these insured individuals were diagnosed with late‐stage CRC.

Từ khóa


Tài liệu tham khảo

American Cancer Society, 2014, Cancer Facts and Figures, 2014

10.7326/0003-4819-149-9-200811040-00245

10.1016/S1542-3565(03)00294-5

10.1053/j.gastro.2008.02.002

10.7326/0003-4819-149-9-200811040-00244

10.1056/NEJMoa1100370

10.1001/jama.296.23.2815

Klabunde CN, 2013, Vital signs: colorectal cancer screening test use—United States, 2012, Morb Mortal Wkly Rep, 62, 881

Iowa Department of Public Health.Health in Iowa Annual Report from the Behavioral Risk Factor Surveillance System: Iowa 2012. Available at:http://www.idph.state.ia.us/brfss/common/pdf/2012BRFSSannual.pdf.Accessed May 15 2015.

10.5993/AJHB.36.2.2

10.1016/j.amepre.2005.11.006

10.1016/j.amepre.2006.04.008

10.1016/j.pec.2011.04.010

10.1016/j.ypmed.2004.11.004

10.1001/jamasurg.2013.5062

10.1016/j.cgh.2012.11.025

10.1111/j.1748-0361.2011.00365.x

10.1002/cam4.40

James TM, 2006, Disparities in colorectal cancer screening: a guideline‐based analysis of adherence, Ethn Dis, 16, 228

10.2105/AJPH.2013.301572

10.1111/jrh.12104

Kaiser Family Foundation.Medicare advantage enrollees as a percent of total Medicare population; 2014. Available at:http://kff.org/medicare/state‐indicator/enrollees‐as‐a‐of‐total‐medicare‐population/. Accessed December 19 2014.

Edge SB, 2010, AJCC Cancer Staging Manual. 7th ed

University of Iowa Carver College of Medicine Office of Statewide Clinical Education Programs. Available at:http://www.medicine.uiowa.edu/oscep/products/. Accessed July 22 2014.

10.1186/1476-072X-12-56

University of Washington Rural Health Resource Center. RUCA Data. Available at:http://depts.washington.edu/uwruca/ruca‐uses.php. Accessed December 1 2014.

Centers for Medicare & Medicaid Services. Medicare Coverage of Ambulance Services.2015. Available at:https://www.medicare.gov/Pubs/pdf/11021.pdf. Accessed July 20 2015.

Centers for Disease Control and Prevention, 2013, Vital signs: colorectal cancer screening test use–United States, 2012, Morb Mortal Wkly Rep, 62, 881

10.1258/0969141053279095

10.1258/jms.2010.010036

10.1136/gut.2009.192948

10.1055/s-2007-966182

10.1016/j.canep.2012.02.006

10.1258/jms.2008.008004

10.1093/jnci/djn404

10.1097/00008469-200402000-00004

10.3747/co.20.1646

10.5694/j.1326-5377.2011.tb03766.x

Thông tin
Thông tin xuất bản

Journal of Rural Health

Tập 32 Số 4

363-373

Thông tin tác giả