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Disparities in colon cancer screening in the Medicare population. Arch Intern Med 2007 Feb 12;167(3):258-64



Pubmed ID




Scopus ID

2-s2.0-33846984978   108 Citations


BACKGROUND: Colorectal cancer is the third most common cancer in the United States, but the rate of screening remains low. Since 2001, Medicare has provided coverage of colonoscopy for colorectal cancer screening in individuals at average risk, but little is known about the effect of this coverage on screening or disparities in screening practices.

METHODS: We examined the Medicare physician/supplier billing claims file for New York, Florida, and Illinois for the years 2002 and 2003. Using a previously employed algorithm, we identified the rates of colorectal screening tests in individuals at average risk. We performed multivariate logistic regression analysis to calculate the effects of sex, racial/ethnic, and socioeconomic characteristics on screening. We also looked for interactions between socioeconomic and demographic variables.

RESULTS: A total of 596 470 Medicare beneficiaries were included in the study. Approximately 18.3% of the population had undergone a screening colon test during the study period. Nonwhite persons were less likely to be screened for colorectal cancer than were white persons (relative risk [RR], 0.52; 95% confidence interval [CI], 0.50-0.53). The lowest RR of screening colonoscopy in women compared with men was in the oldest age group and the highest income tertile (RR for whites, 0.64; 95% CI, 0.59-0.70). Higher income level was associated with screening colonoscopy in white patients (men: RR, 1.19; 95% CI, 1.14-1.25; women: RR, 1.09; 95% CI, 1.05-1.15) but not in nonwhite patients (men: RR, 0.97; 95% CI, 0.78-1.22; women: RR, 0.94; 95% CI, 0.78-1.14).

CONCLUSION: Despite the expansion of Medicare coverage for colorectal cancer screening, there still remain significant disparities between sex and racial/ethnic groups in screening practices.

Author List

Ananthakrishnan AN, Schellhase KG, Sparapani RA, Laud PW, Neuner JM


Joan Neuner MD, MPH Professor in the Medicine department at Medical College of Wisconsin
Kenneth G. Schellhase MD, MPH Adjunct Professor in the Family Medicine department at Medical College of Wisconsin
Rodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Colonic Neoplasms
Diagnostic Techniques, Digestive System
Mass Screening
New York
Sex Factors
Socioeconomic Factors