Kristen Hassmiller Lich, PhD

Credit: University of North Carolina at Chapel Hill

There are several predictors for being up-to-date on colorectal cancer screenings for older adults, including insurance type, distance to the nearest endoscopy facility, and being high school educated.¹

A team, led by Kristen Hassmiller Lich, PhD, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, examined both individual and county-level predictors for staying up-to-date on colorectal cancer screenings past the age of 45.

“Routine CRC screening is the most effective way to reduce risk of and death from [colorectal cancer],” the authors wrote. “An individual is considered up-to-date with [colorectal cancer] screening if they have a colonoscopy at least once every 10 years.”

New Guidelines

Recently, the guidelines for colorectal cancer screenings were updated where it is recommended for all individuals aged 45-75 years to regularly receiving screenings. Prior to 2021, the recommendations were for all individuals beginning at age 50.

There is currently a need to assess the factors associated with being up-to-date for colorectal cancer screening to identify populations where targeted interventions could be needed.

In the study, the investigators used Medicare and private insurance claims for data on residents of North Carolina to identify up-to-date status in the 10th year of continuous enrollment in the claims data and in the available subsequent years. They used guidelines from the United States Preventative Service Task Force (USPSTF) to define up-to-date status for multiple recommended modalities and used Area Health Resources Files for geographic and health care service provider data at the county level.

The team also used a generalized estimating equation logistic regression model to examine the association between individual- and county-level characteristics and being up-to-date with colorectal cancer screening.

Staying Up-to-Date

The results show 75% (n = 274,660) participants aged 59-75 years were up-to-date between 2012-2016. The investigators also identified several individual predictors including sex, age, insurance type, recent visits with a primary care provider, distance to nearest endoscopy facility, and insurance type, as well as county-level predictors, such as percentage of residents with a high school education, without insurance, and unemployed as being up-to-date.

An example of this is individuals with higher odds of being up-to-date were aged 73-75 years compared to aged 59 years (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.09, 1.15).

This was also true for individuals living in counties with more primary care physicians (OR, 1.03; 95% CI, 1.01-1.06).

“This study identified 12 individual- and county-level demographic characteristics related to being up-to-date with screening to inform how interventions may optimally be targeted,” the authors wrote.

References:

Lich, K.H., Mills, S.D., Kuo, TM. et al. Multi-level predictors of being up-to-date with colorectal cancer screening. Cancer Causes Control (2023). https://doi.org/10.1007/s10552-023-01723-w