Impact of expanded Medicare coverage on colorectal cancer screening rates for people with and without disabilities

Background. In 2001, Medicare coverage for colorectal cancer (CRC) screening was expanded to include people at average risk in an attempt to increase screening rates. This study assesses the impact of Medicare's expansion of CRC screening coverage on elderly adults with disabilities.

Methods. Data from the 2001 and 2004 Behavioral Risk Factor Surveillance System (BRFSS) surveys were used to estimate differences in CRC screening, including use of fecal occult blood tests (FOBT) and/or lower endoscopy (colonoscopy or sigmoidoscopy), among US adults aged 65 years and older based on self-reported disability status. We also evaluated the impact of Medicare's expanded coverage on CRC screening rates among those with and without disabilities.

Results. Overall CRC screening rates among adults aged 65 years and older increased between 2001 and 2004 (60.7% vs. 65.7%; p<0.01). This increase was due to increased lower endoscopy screening rates (51.0% vs. 58.8%; p<0.001). FOBT rates decreased (27.3% vs. 22.1%; p<0.001) between 2001 and 2004. In 2001, older adults with disabilities were more likely than their non-disabled peers to be screened for CRC (63.7% vs. 59.4%; p<0.001), however the difference narrowed by 2004 (66.1% vs. 65.6%; p=0.54).

Conclusions. While Medicare CRC coverage expansion was successful in removing financial barriers to care for the elderly, others barriers to care faced by elderly people with disabilities remain formidable. To improve CRC screening rates states and others need to identify and reduce barriers to preventive care experienced by people with disabilities.