207260 Predictors of Endoscopic Colorectal Cancer Screening over Time in 11 States

Tuesday, November 10, 2009: 2:35 PM

Lee Mobley, PhD , Discovery and Analytical Sciences, RTI International, Research Triangle Park, NC
Background: Colorectal cancer (CRC) ranks third among all cancer sites in incidence, and second in cancer-related mortality. CRC screening is essential for early detection of colorectal cancer and both reduced morbidity and increased survival among cancer victims, but screening rates are suboptimal.

Objective(s): To study predictors of CRC screening behavior in a cohort of Medicare-enrolled persons over a period during which coverage for CRC screening increased (2000-2005). The study population includes 272,077 men and women who are age 65+ in 2000 and remain alive through 2005, located in 11 SEER Registry states that span all census regions and exhibit heterogeneous socio-demographics.

Methods: We use multilevel logistic regression of a binary probit choice model over two time intervals (2000-2002, 2003-2005) and assess empirically whether predicted effects are different across states and time. Gender, previous cancer diagnosis, disability as the original reason for entitlement, and dual eligibility are key person-specific factors of interest. Social segregation, commuter intensity, availability of CRC screening facilities, availability of oncologists and gastroenterologists, poverty, and income disparity are key environmental variables.

Results : The geographic variation in utilization and its associated factors provide insights regarding the heterogeneity of supply-demand systems and realized utilization of CRC services across the landscape. Men are not universally more likely than women to utilize CRC screening; African Americans are not universally less likely to be screened than whites; and disparities between minorities and whites appear to decrease over time. Policy interventions to improve screening rates should consider local community characteristics.

Learning Objectives:
By the end of the session, the participant will be able to recognize that geographic disparities may obscure inter-personal disparities, necessitating separate analyses in different states or regions, rather than pooling data across multiple states. Participants will learn that targeting interventions to communities with especially low screening rates and specific community profiles may be facilitated by the methods used here.

Keywords: Cancer Screening, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the PI on the R01 grant funded by NCI which supports this work
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Cancer Screening and Prevention
See more of: Epidemiology