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Glaser KM, Crabtree-Ide CR, McNulty AD, Attwood KM, Flores TF, Krolikowski AM, Robillard KT, Reid ME. Improving Guideline-Recommended Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC): Implementing a Patient Navigation and Practice Facilitation Intervention to Promote Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:126. [PMID: 38397617 PMCID: PMC10887785 DOI: 10.3390/ijerph21020126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is effective in the prevention and early detection of cancer. Implementing evidence-based screening guidelines remains a challenge, especially in Federally Qualified Health Centers (FQHCs), where current rates (43%) are lower than national goals (80%), and even lower in populations with limited English proficiency (LEP) who experience increased barriers to care related to systemic inequities. METHODS This quality improvement (QI) initiative began in 2016, focused on utilizing patient navigation and practice facilitation to addressing systemic inequities and barriers to care to increase CRC screening rates at an urban FQHC, with two clinical locations (the intervention and control sites) serving a diverse population through culturally tailored education and navigation. RESULTS Between August 2016 and December 2018, CRC screening rates increased significantly from 31% to 59% at the intervention site (p < 0.001), with the most notable change in patients with LEP. Since 2018 through December 2022, navigation and practice facilitation expanded to all clinics, and the overall CRC screening rates continued to increase from 43% to 50%, demonstrating the effectiveness of patient navigation to address systemic inequities. CONCLUSIONS This multilevel intervention addressed structural inequities and barriers to care by implementing evidence-based guidelines into practice, and combining patient navigation and practice facilitation to successfully increase the CRC screening rates at this FQHC.
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Affiliation(s)
- Kathryn M. Glaser
- Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Christina R. Crabtree-Ide
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
| | - Alyssa D. McNulty
- Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Kristopher M. Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Tessa F. Flores
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
| | | | - Kevin T. Robillard
- Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Mary E. Reid
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
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2
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Wang CP, Vang SS, Cheung AJ, Lin JJ, Jandorf LH. A Community-Based Survey of Colorectal Cancer Screening Behaviors in Chinese Immigrants Residing in a Major Metropolitan Area. JOURNAL OF COMMUNITY MEDICINE & PUBLIC HEALTH 2023; 7:336. [PMID: 38765318 PMCID: PMC11101160 DOI: 10.29011/2577-2228.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Colorectal cancer is a common cause of screening preventable death in Chinese immigrants, but colorectal cancer screening rates remain low in this population. This study evaluated factors associated with colorectal cancer screening behaviors in Chinese Americans living in New York City. Methods Participants were foreign-born Chinese Americans, aged 50 years or older, who completed internet surveys between November 2020 and May 2021 regarding their colorectal cancer screening behaviors. Data were collected on demographics, health care utilization, participants' levels of health literacy, English proficiency, colorectal cancer perceptions and current colorectal cancer screening behaviors. Bivariate analyses using chi-square or t-tests were performed to examine associations between colorectal cancer screening behaviors and participant characteristics. Results 103 participants were surveyed with a mean age of 71.3 years. Most participants experienced high rates of socioeconomic disadvantage (i.e., less than a high school education, annual household income <$20,000, limited health literacy, and poor English proficiency). 92% were ever screened, 81% were up-to-date on screening, and 85% expressed intention to screen in the future. Almost all participants had a primary care provider and a language concordant provider. Individuals who intended to screen were more fearful of developing colorectal cancer (3.2 vs 2.8, p=0.02) and perceived a colorectal cancer diagnosis with greater severity (3.0 vs 2.7, p=0.07) than those without intention to screen. Conclusions In our sample, Chinese immigrants were adversely impacted by multiple social determinants of health but reported high colorectal cancer screening rates. Community-based outreach is critical to ensuring cancer-screening engagement in medically vulnerable populations.
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Affiliation(s)
- Christina P Wang
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suzanne S Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Aaron J Cheung
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- BS program, School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina H Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zhan FB, Liu Y, Yang M, Kluz N, Olmstead TA, Spencer J, Shokar NK, Cruz RL, Pignone MP. Using GIS to Identify Priority Sites for Colorectal Cancer Screening Programs in Texas Health Centers. Prev Chronic Dis 2023; 20:E10. [PMID: 36862605 PMCID: PMC9983600 DOI: 10.5888/pcd20.220205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Affiliation(s)
- F Benjamin Zhan
- Texas Center for Geographic Information Science, Department of Geography and Environmental Studies, Texas State University, San Marcos, TX 78666 .,Cancer Prevention and Control Program, LiveStrong Cancer Institutes, Dell Medical School, University of Texas at Austin.,Department of Population Health, Dell Medical School, University of Texas at Austin
| | - Yanyan Liu
- Texas Center for Geographic Information Science, Department of Geography and Environmental Studies, Texas State University, San Marcos, Texas
| | - Mei Yang
- Texas Center for Geographic Information Science, Department of Geography and Environmental Studies, Texas State University, San Marcos, Texas
| | - Nicole Kluz
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin
| | - Todd A Olmstead
- University of Texas at Austin, LBJ School of Public Affairs, Austin, Texas
| | - Jenny Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin.,Department of Internal Medicine, Dell Medical School, University of Texas at Austin
| | - Navkiran K Shokar
- Cancer Prevention and Control Program, LiveStrong Cancer Institutes, Dell Medical School, University of Texas at Austin.,Department of Population Health, Dell Medical School, University of Texas at Austin
| | - Roxana L Cruz
- Texas Association of Community Health Centers, Austin, Texas
| | - Michael P Pignone
- Cancer Prevention and Control Program, LiveStrong Cancer Institutes, Dell Medical School, University of Texas at Austin.,Department of Population Health, Dell Medical School, University of Texas at Austin.,Department of Internal Medicine, Dell Medical School, University of Texas at Austin
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Poulson MR, Geary A, Papageorge M, Laraja A, Sacks O, Hall J, Kenzik KM. The effect of medicare and screening guidelines on colorectal cancer outcomes. J Natl Med Assoc 2023; 115:90-98. [PMID: 36470707 DOI: 10.1016/j.jnma.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/17/2022] [Accepted: 09/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal cancer screening has been shown effective at reducing stage at presentation, but there is differential uptake of screening based on insurance status. We sought to determine the population-level effect of Medicare and screening guidelines on colorectal screening by race and region. METHODS Data on Black and white patients with colorectal cancer were obtained from the SEER database. Regression discontinuity was used to assess the causal effect of near-universal health insurance (represented by age 65) and United States Preventive Services Task Force guidelines (age 50) on the proportion of people presenting at advanced stage. This was stratified by race and region. RESULTS In the Southern United States, Black patients saw a significant decrease in advanced stage at presentation at age 65 (coefficient -0.12, p = 0.003), while white patients did not (coefficient -0.03, p = 0.09). At age 50, neither Black (coefficient 0.09, p = 0.10) nor white patients (coefficient -0.04, p = 0.1) saw a significant decrease in advanced stage. In the Western U.S., neither Black (coefficient 0.02, p = 0.72) or white patients (coefficient -0.02, p = 0.09) saw a significant decrease in advanced stage at age 65; however, both Black (coefficient -0.20, p = 0.008) and white patients (coefficient -0.05, p = 0.03) saw a significant decrease at age 50. CONCLUSIONS Our data highlight the significant impact that near-universal insurance has on reducing colorectal cancer stage at presentation in areas with poor baseline insurance coverage, particularly for Black patients. To reduce disparities in advanced stage at presentation for colorectal cancer, state-level insurance coverage should be addressed.
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Affiliation(s)
- Michael R Poulson
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Marianna Papageorge
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Alexander Laraja
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Olivia Sacks
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jason Hall
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Kelly M Kenzik
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama-Birmingham, Birmingham, AL, USA.
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Price-Haywood EG, Burton JH. Racial Differences in Strength of Associations Between Colorectal Cancer Screening, Area Deprivation, Demographics, and Clinical Characteristics. Ochsner J 2023; 23:194-205. [PMID: 37711477 PMCID: PMC10498952 DOI: 10.31486/toj.23.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Background: In Louisiana, colorectal cancer (CRC) incidence and mortality exceed national rates. Census tract, sex, and racial disparities across the state are well documented. This study examined whether there were subpopulation differences in associations between CRC screening, area deprivation index (ADI), and patient characteristics. Methods: This retrospective observational study included patients aged 50 to 75 years who received care within Ochsner Health in Louisiana between July 1, 2012, and December 31, 2020. Logistic regression models were used to generate adjusted odds ratios (95% CI). Results: A total of 75,344 patients met eligibility criteria for inclusion in the data analysis (60% female, 36% Black, 56% with spouse/partner, 42% Medicare/Medicaid,17% living in high deprivation areas, 41% with 2+ chronic conditions, 56% never smoked, 51% obese). Living in areas with less deprivation (state decile 1-3 vs 8-10: 1.19 [1.14-1.24]), number of comorbidities (3+ conditions: 1.15 [1.12-1.17]), and prior outpatient visits (1.63 [1.58-1.67]) increased odds of CRC screening. Male sex (0.82 [0.79-0.84]), age group 55 to 59 years (0.97 [0.95-0.99]), and Medicaid insurance (0.89 [0.86-0.92]) decreased odds of screening. ADI was collinear with sex, race, marital status, body mass index, and smoking status. In subgroup analyses, between-group differences in strength of associations of CRC screening with ADI and patient characteristics varied most prominently by race. Conclusion: There may be an unmeasured social context explaining persistent racial differences among factors associated with CRC screening. A combination of census tract and individual-level social determinants may guide population health management for at-risk subpopulations.
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Affiliation(s)
- Eboni G. Price-Haywood
- Ochsner-Xavier Institute for Health Equity and Research, New Orleans, LA
- Center for Outcomes Research, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
| | - Jeffrey H. Burton
- Center for Outcomes Research, Ochsner Clinic Foundation, New Orleans, LA
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The impact of driving time on participation in colorectal cancer screening with sigmoidoscopy and faecal immunochemical blood test. Cancer Epidemiol 2022; 80:102244. [DOI: 10.1016/j.canep.2022.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/20/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022]
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Occurrence of comorbidity with colorectal cancer and variations by age and stage at diagnosis. Cancer Epidemiol 2022; 80:102246. [PMID: 36067574 DOI: 10.1016/j.canep.2022.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND While age and stage at diagnosis are known to affect treatment choices and survival from colorectal cancer (CRC), few studies have investigated the extent to which these effects are influenced by comorbidity. In this study, we describe the occurrence of comorbidity in CRC cases in South Australia and associations of comorbidity with age, stage and the age-stage relationship. Furthermore, we report on the association of individual comorbidities with age and stage at diagnosis. METHODS The South Australian Cancer Registry (SACR) provided CRC data (C18-C20, ICD-10) for 2004-2013 diagnoses. CRC data were linked with comorbidity data drawn from hospital records and health insurance claims. Logistic regression was used to model associations of comorbidity with age and stage. RESULTS For the 8462 CRC cases in this study, diabetes, peptic ulcer disease, and previous cancers were the most commonly recorded co-existing conditions. Most comorbidities were associated with older age, although some presented more frequently in younger people. Patients at both ends of the age spectrum (<50 and 80 + years) had an increased likelihood of CRC diagnosis at an advanced stage compared with other ages (50-79 years old). Adjusting for comorbidities moderated the association of older age with advanced stage. Conditions associated with advanced stage included dementia (OR = 1.25 (1.01-1.55)), severe liver disease (OR = 1.68 (1.04-2.70)), and a previous cancer (OR = 1.18 (1.08-1.28)). CONCLUSION Comorbidities are prevalent with CRC, especially in older people. These comorbidities differ in their associations with age at diagnosis and stage. Dementia and chronic heart failure were associated with older age whereas inflammatory bowel disease and alcohol access were associated with younger onset of the disease. Severe liver disease and dementia were associated with more advanced stage and rheumatic disease with less advanced stage. Comorbidities also interact with age at diagnosis and appear to vary the likelihood of advanced-stage disease. CRC patient have different association of age with stage depending on their comorbidity status.
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Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population? GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3040018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
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Area-Level Determinants in Colorectal Cancer Spatial Clustering Studies: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910486. [PMID: 34639786 PMCID: PMC8508304 DOI: 10.3390/ijerph181910486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 12/12/2022]
Abstract
The increasing pattern of colorectal cancer (CRC) in specific geographic region, compounded by interaction of multifactorial determinants, showed the tendency to cluster. The review aimed to identify and synthesize available evidence on clustering patterns of CRC incidence, specifically related to the associated determinants. Articles were systematically searched from four databases, Scopus, Web of Science, PubMed, and EBSCOHost. The approach for identification of the final articles follows PRISMA guidelines. Selected full-text articles were published between 2016 and 2021 of English language and spatial studies focusing on CRC cluster identification. Articles of systematic reviews, conference proceedings, book chapters, and reports were excluded. Of the final 12 articles, data on the spatial statistics used and associated factors were extracted. Identified factors linked with CRC cluster were further classified into ecology (health care accessibility, urbanicity, dirty streets, tree coverage), biology (age, sex, ethnicity, overweight and obesity, daily consumption of milk and fruit), and social determinants (median income level, smoking status, health cost, employment status, housing violations, and domestic violence). Future spatial studies that incorporate physical environment related to CRC cluster and the potential interaction between the ecology, biology and social determinants are warranted to provide more insights to the complex mechanism of CRC cluster pattern.
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Kelly TA, Kim S, Jemmott LS, Jemmott JB. Predictors of Colorectal Cancer Screening Among African American Men Living with HIV. J Community Health 2021; 46:1099-1106. [PMID: 33963984 DOI: 10.1007/s10900-021-00997-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 01/22/2023]
Abstract
African American men living with HIV are at high risk of colorectal cancer (CRC). Screening to detect CRC is associated with a reduced risk of CRC mortality. However, little is known about CRC screening predictors in this population. This study examined the relation of self-efficacy, a potential mediator of screening that interventions could target, to CRC screening. It also investigated several variables that might identify subpopulations of African American men non-adherent to CRC screening recommendations. We report a secondary analysis on baseline data from a randomized controlled trial of a health promotion intervention for African American men living with HIV. Before their intervention, they completed measures of CRC screening, self-efficacy, marital status, age, education, and adherence to physical activity guidelines and were assessed for obesity. A total of 270 African American men aged 45 to 88 (Mean = 55.07; SD = 6.46) living with HIV participated. About 30% reported CRC screening in the past six months. Multiple logistic regression revealed greater CRC screening self-efficacy and meeting physical activity guidelines were associated with receiving CRC screening. Obese men and men reporting higher education were less likely to report screening. Age and marital status were unrelated to screening. The results of this study suggest CRC screening rates may be low among African American men living with HIV, and interventions targeting self-efficacy may improve their screening uptake. Moreover, public-health efforts to increase screening should prioritize interventions with subpopulations of African American men living with HIV who are physically inactive and obese.
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Affiliation(s)
- Terri-Ann Kelly
- Rutgers University-Camden School of Nursing, 530 Federal Street, Office 448, Camden, NJ, 08102, USA.
| | | | - Loretta S Jemmott
- Drexel University College of Nursing and Health Professions, Philadelphia, USA
| | - John B Jemmott
- University Pennsylvania Annenberg School of Communication, Philadelphia, USA
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Zhan FB, Morshed N, Kluz N, Candelaria B, Baykal-Caglar E, Khurshid A, Pignone MP. Spatial Insights for Understanding Colorectal Cancer Screening in Disproportionately Affected Populations, Central Texas, 2019. Prev Chronic Dis 2021; 18:E20. [PMID: 33661726 PMCID: PMC7938962 DOI: 10.5888/pcd18.200362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) screening can reduce morbidity and mortality; however, important disparities exist in CRC uptake. Our study examines the associations of distance to care and frequency of using primary care and screening. METHODS To examine the distribution of screening geographically and according to several demographic features, we used individual patient-level data, dated September 30, 2018, from a large urban safety-net health system in Central Texas. We used spatial cluster analysis and logistic regression adjusted for age, race, sex, socioeconomic status, and health insurance status. RESULTS We obtained screening status data for 13,079 age-eligible patients from the health system's electronic medical records. Of those eligible, 55.1% were female, and 55.9% identified as Hispanic. Mean age was 58.1 years. Patients residing more than 20 miles from one of the system's primary care clinics was associated with lower screening rates (odds ratio [OR], 0.63; 95% CI, 0.43-0.93). Patients with higher screening rates included those who had a greater number of primary care-related (nonspecialty) visits within 1 year (OR, 6.90; 95% CI, 6.04-7.88) and those who were part of the county-level medical assistance program (OR, 1.61; 95% CI, 1.40-1.84). Spatial analysis identified an area where the level of CRC screening was particularly low. CONCLUSION Distance to primary care and use of primary care were associated with screening. Priorities in targeted interventions should include identifying and inviting patients with limited care engagements.
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Affiliation(s)
- F Benjamin Zhan
- LiveStrong Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
- Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos, TX 78666.
| | - Niaz Morshed
- Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos, Texas
| | - Nicole Kluz
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | - Bretta Candelaria
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | | | - Anjum Khurshid
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | - Michael P Pignone
- LiveStrong Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
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Miller-Wilson LA, Rutten LJF, Van Thomme J, Ozbay AB, Limburg PJ. Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a large, nationally insured cohort. Int J Colorectal Dis 2021; 36:2471-2480. [PMID: 34019124 PMCID: PMC8138513 DOI: 10.1007/s00384-021-03956-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Colorectal cancer (CRC) is the second most deadly cancer in the USA. Early detection can improve CRC outcomes, but recent national screening rates (62%) remain below the 80% goal set by the National Colorectal Cancer Roundtable. Multiple options are endorsed for average-risk CRC screening, including the multi-target stool DNA (mt-sDNA) test. We evaluated cross-sectional mt-sDNA test completion in a population of commercially and Medicare-insured patients. METHODS Participants included individuals ages 50 years and older with commercial insurance or Medicare, with a valid mt-sDNA test shipped by Exact Sciences Laboratories LLC between January 1, 2018, and December 31, 2018 (n = 1,420,460). In 2020, we analyzed cross-sectional adherence, as the percent of successfully completed tests within 365 days of shipment date. RESULTS Overall cross-sectional adherence was 66.8%. Adherence was 72.1% in participants with Traditional Medicare, 69.1% in participants with Medicare Advantage, and 61.9% in participants with commercial insurance. Adherence increased with age: 60.8% for ages 50-64, 71.3% for ages 65-75, and 74.7% for ages 76 + years. Participants with mt-sDNA tests ordered by gastroenterologists had a higher adherence rate (78.3%) than those with orders by primary care clinicians (67.2%). Geographically, adherence rates were highest among highly rural patients (70.8%) and ordering providers in the Pacific region (71.4%). CONCLUSIONS Data from this large, national sample of insured patients demonstrate high cross-sectional adherence with the mt-sDNA test, supporting its role as an accepted, noninvasive option for average-risk CRC screening. Attributes of mt-sDNA screening, including home-based convenience and accompanying navigation support, likely contributed to high completion rates.
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