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Effect of an equal-access military health system on racial disparities in colorectal cancer screening.
- Source :
-
Cancer [Cancer] 2018 Sep 15; Vol. 124 (18), pp. 3724-3732. Date of Electronic Publication: 2018 Sep 12. - Publication Year :
- 2018
-
Abstract
- Background: Racial disparities in colorectal cancer (CRC) screening are frequently attributed to variations in insurance status. The objective of this study was to ascertain whether universal insurance would lead to more equitable utilization of CRC screening for black patients in comparison with white patients.<br />Methods: Claims data from TRICARE (insurance coverage for active, reserve, and retired members of the US Armed Services and their dependents) for 2007-2010 were queried for adults aged 50 years in 2007, and they were followed forward in time for 4 years (ages, 50-53 years) to identify their first lower endoscopy and/or fecal occult blood test (FOBT). Variations in CRC screening were compared with descriptive statistics and multivariate logistic regression.<br />Results: Among the 24,944 patients studied, 69.2% were white, 20.3% were black, 4.9% were Asian, and 5.6% were other. Overall, 54.0% received any screening: 83.7% received endoscopy, and 16.3% received FOBT alone. Compared with whites, black patients had higher screening rates (56.5%) and had 20% higher risk-adjusted odds of being screened (95% confidence interval [CI], 1.11-1.29). Asian patients had a likelihood of screening similar to that of white patients (odds ratio [OR], 1.06; 95% CI, 0.92-1.23). Females (OR, 1.20; 95% CI, 1.10-1.33), active-duty personnel (OR, 1.15; 95% CI, 1.06-1.25), and officers (OR, 1.28; 95% CI, 1.18-1.37) were also more likely to be screened.<br />Conclusion: Within an equal-access, universal health care system, black patients had higher rates of CRC screening in comparison with prior reports and even in comparison with white patients within the population. These findings highlight the need to understand and develop meaningful approaches for promoting more equitable access to preventative care. Moreover, equal-access, universal health insurance for both the military and civilian populations can be presumed to improve access for underserved minorities.<br /> (© 2018 American Cancer Society.)
- Subjects :
- Colorectal Neoplasms economics
Colorectal Neoplasms ethnology
Early Detection of Cancer economics
Early Detection of Cancer methods
Endoscopy, Gastrointestinal economics
Endoscopy, Gastrointestinal statistics & numerical data
Female
Health Services Accessibility economics
Health Services Accessibility organization & administration
Healthcare Disparities economics
Humans
Insurance Claim Review statistics & numerical data
Insurance Coverage economics
Insurance Coverage statistics & numerical data
Male
Mass Screening economics
Mass Screening methods
Mass Screening statistics & numerical data
Middle Aged
Occult Blood
United States epidemiology
Veterans Health economics
Veterans Health statistics & numerical data
Colorectal Neoplasms diagnosis
Early Detection of Cancer statistics & numerical data
Health Services Accessibility statistics & numerical data
Healthcare Disparities statistics & numerical data
Military Medicine economics
Military Medicine organization & administration
Military Medicine statistics & numerical data
Military Personnel statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1097-0142
- Volume :
- 124
- Issue :
- 18
- Database :
- MEDLINE
- Journal :
- Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 30207379
- Full Text :
- https://doi.org/10.1002/cncr.31637