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Effect of an equal‐access military health system on racial disparities in colorectal cancer screening
Author(s) -
Changoor Navin R.,
Pak Linda M.,
Nguyen Louis L.,
Bleday Ronald,
Trinh QuocDien,
Koehlmoos Tracey,
Learn Peter A.,
Haider Adil H.,
Goldberg Joel E.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31637
Subject(s) - medicine , fecal occult blood , odds ratio , confidence interval , colorectal cancer , logistic regression , colonoscopy , demography , cancer , cancer screening , odds , sociology
BACKGROUND Racial disparities in colorectal cancer (CRC) screening are frequently attributed to variations in insurance status. The objective of this study was to ascertain whether universal insurance would lead to more equitable utilization of CRC screening for black patients in comparison with white patients. METHODS Claims data from TRICARE (insurance coverage for active, reserve, and retired members of the US Armed Services and their dependents) for 2007‐2010 were queried for adults aged 50 years in 2007, and they were followed forward in time for 4 years (ages, 50‐53 years) to identify their first lower endoscopy and/or fecal occult blood test (FOBT). Variations in CRC screening were compared with descriptive statistics and multivariate logistic regression. RESULTS Among the 24,944 patients studied, 69.2% were white, 20.3% were black, 4.9% were Asian, and 5.6% were other. Overall, 54.0% received any screening: 83.7% received endoscopy, and 16.3% received FOBT alone. Compared with whites, black patients had higher screening rates (56.5%) and had 20% higher risk‐adjusted odds of being screened (95% confidence interval [CI], 1.11‐1.29). Asian patients had a likelihood of screening similar to that of white patients (odds ratio [OR], 1.06; 95% CI, 0.92‐1.23). Females (OR, 1.20; 95% CI, 1.10‐1.33), active‐duty personnel (OR, 1.15; 95% CI, 1.06‐1.25), and officers (OR, 1.28; 95% CI, 1.18‐1.37) were also more likely to be screened. CONCLUSION Within an equal‐access, universal health care system, black patients had higher rates of CRC screening in comparison with prior reports and even in comparison with white patients within the population. These findings highlight the need to understand and develop meaningful approaches for promoting more equitable access to preventative care. Moreover, equal‐access, universal health insurance for both the military and civilian populations can be presumed to improve access for underserved minorities.