Did Medicare coverage of colonoscopy reduce rural-urban disparities in colorectal cancer screening?

Background: Studies of Medicare population demonstrated rural-urban disparity in colorectal cancer (CRC) screening. It is unknown how expansion of Medicare coverage for colonoscopy in 2001 affected screening in rural areas and disparity. Objective: To examine: (1) the trend in CRC screening among rural and urban areas between 2000 and 2005; and (2) whether the rural-urban disparity was reduced after the expansion of Medicare coverage. Methods: We included community dwelling beneficiaries aged 65 and older from 2000, 2003 and 2005 Medicare Current Beneficiary Survey. Rural-Urban Commuting Area Codes were used to characterize 4 categories of rural and urban status. CRC screening was defined as FOBT in last year or colonoscopy/sigmoidoscopy in past 5 years. Multivariate logistic regression was performed to determine the trend and rural-urban disparity during the period. Result: There was an increase in CRC screening in both rural and urban areas between 2000 and 2005 ( from 48.5% to 55.5% among urban areas; from 42.6% to 50.0% among large rural areas; from 35.1% to 47.4% among small rural areas; and from 38.7% to 42.7% among isolated rural areas.While the rural-urban disparity persisted over this time, the magnitude of the disparity appeared to decrease (from 13.4% in 2000 to 8.1% in 2005) between small rural and urban areas, p=0.03). Conclusions: After Medicare's expansion of colonoscopy in 2001, there was an increase in CRC screening uptake. However, rural-urban disparity persisted during the period. The disparity between small rural and urban areas in 2005 was reduced.