Study: With universal coverage, minority CRC screening still low

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Medicare’s expansion of coverage for colorectal cancer (CRC) screening has failed to eliminate racial disparities, with blacks and Hispanics significantly less likely to undergo CRC than whites, a study published in the May issue of Cancer, Epidemiology, Biomarkers & Prevention found.

With colorectal cancer ranking as the third most common form of nonskin cancer among men and women in the U.S., the Centers for Medicare & Medicaid Services expanded reimbursements to cover screening fecal occult blood testing (annually) and colonoscopy (every 10 years) for all average-risk Medicare beneficiaries in 1998 and 2001, respectively.

A number of studies have determined that CRC screening is suboptimal among all eligible adults (at roughly 50 percent), and lack of coverage has widely been considered to stand as a key barrier, explained Arica White, PhD, MPH, and co-authors from the School of Public Health at the University of Texas Health Science Center in Houston. Moreover, screening rates have been shown to be especially low among racial and ethnic minorities.

White and colleagues randomly sampled nearly 31,000 Medicare beneficiaries aged 70 to 89 to assess whether Medicare’s introduction of universal coverage for CRC had narrowed the gap in screening observed between whites and minorities. Only individuals without histories of cancer were included in the study.

The authors found that minorities continued to undergo significantly less screening after Medicare’s expansion of coverage. Using whites as the reference (1.00), the odds ratio of blacks undergoing CRC screening was 0.80. Asians/Pacific Islanders and Hispanics were also less likely to undergo CRC screening, with odds ratios of 0.77 and 0.73, respectively.

Although the odds that blacks and whites would undergo screening did increase for both groups following Medicare’s expansion of coverage, Hispanics’ and Asian/Pacific Islanders’ age-gender-adjusted odds of undergoing CRC screening actually decreased after universal coverage was implemented.

Overall, following the expansion of coverage, the age-gender adjusted likelihood that whites underwent guideline-specific screening was approximately 28 percent, compared with 24 percent of Asians, 23 percent of blacks and 21 percent of Hispanics. The authors noted that because the study tracked changes over only five years (whereas colonoscopy is recommended only once every 10 years), the rates would be artificially lower.

“These disparities should not exist within this universally insured population,” wrote White and colleagues. They conjectured that health beliefs, health education, access and socioeconomic status were likely contributors to these differences.

“Future studies should explore other factors beyond health insurance that may contribute to screening disparities such as physician recommendation and language/cultural barriers in this and younger populations,” White and colleagues concluded.