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Impact of Health Insurance, Poverty, and Comorbidities on Colorectal Cancer Screening: Insights from the Medical Expenditure Panel Survey

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Abstract

Background

Despite national campaigns and other efforts to improve colorectal cancer (CRC) screening, participation rates remain below targets set by expert panels. We hypothesized that availability and practice patterns of healthcare providers may contribute to this gap.

Method

Using data of the Medical Expenditure Panel Survey for the years between 2000 and 2016, we extracted demographic, socioeconomic, and health-related data as well as reported experiences about barriers to care, correlating results with answers about recent participation in colorectal cancer screening. As CRC screening guidelines recommend initiation of testing at age 50, we focused on adults 50 years or older.

Results

We included responses of 163,564 participants for the period studied. There was a significant increase in CRC screening rates over time. Comorbidity burden, poverty, race, and ethnicity independently predicted participation in screening. Lack of insurance coverage and cost of care played an important role as reported barrier. Convenient access to care, represented by availability of appointments beyond typical business hours, and frequency of provider interactions, correlated with higher rates of screening.

Conclusion

Our data show a positive effect of educational efforts and healthcare reform with coverage of screening. Easy and more frequent access to individual providers predicted a higher likelihood of completed screening tests. This finding could translate into more widespread implementation of screening programs, as the increasingly common virtual care delivery offers a new and convenient option to patients.

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Author information

Authors and Affiliations

  1. VA Salt Lake City Health Care System, Salt Lake City, UT, USA

    Andrew J. Gawron, Judith Staub & Klaus Bielefeldt

  2. Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Andrew J. Gawron, Judith Staub & Klaus Bielefeldt

  3. George E. Whalen VA Medical Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT, 84148, USA

    Klaus Bielefeldt

Authors
  1. Andrew J. Gawron
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  2. Judith Staub
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Correspondence to Klaus Bielefeldt.

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As all data were extracted from deidentified and publicly available sources, informed consent or IRB approval is not needed. All authors approved the final version of the manuscript.

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Supplementary material 1 (DOCX 18 kb)

10620_2020_6541_MOESM2_ESM.tif

Bar graph depicting the reported time period between the administration of the MEPS questionnaire and the most recent CRC screening test. Data are expressed as percentage of responses providing this information (TIFF 660 kb)

10620_2020_6541_MOESM3_ESM.tif

Histogram showing the percentage of persons in different age cohorts who did or did not complete CRC screening (Х2=2192; P<0.001). (TIFF 648 kb)

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Gawron, A.J., Staub, J. & Bielefeldt, K. Impact of Health Insurance, Poverty, and Comorbidities on Colorectal Cancer Screening: Insights from the Medical Expenditure Panel Survey. Dig Dis Sci 66, 70–77 (2021). https://doi.org/10.1007/s10620-020-06541-7

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  • DOI: https://doi.org/10.1007/s10620-020-06541-7

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