Table 17Studies of insurance status as a predictor of CRC screening

Author, Year
Study Design
Population Setting
Sample Size
Study AimsPrimary Outcome of Interest for Review (i.e., screening or followup after abnormal FOBT; completion rates or discussions)Predictors ExaminedPotential Confounders/Modifiers ReportedVariables Associated with CRC ScreeningResults (95% CI)
Cairns et al., 200656

Cross-sectional, national

HINTS, 2002‐2003, 50–64 years

N = 1,253

Examine the role of communication factors and insurance on CRC screening.FOBT within the past year (self-report)Insurance coverage vs. no coverageAge, insurance, whether there is a usual provider, gender, race/ethnicity, annual household income, employment, rural vs. urban county, education↓ uninsuredUninsured were 64% less likely to be screened than the insured (AOR, 0.36; 95% CI, 0.241–0.536; P < 0.001)
de Bosset, et al., 2008160

Cross-sectional, state

BRFSS, 2005, Virginia residents 50 years or older

N = 2,887

Examine whether self-reported insurance coverage was associated with CRC screeningFOBT within past year and/or lower endoscopy within past 5 years(self-report)Insurance coverage vs. no coverageGender, age, education, income, employment, having seen physician in previous year↓ uninsured malesInsured males were more likely to report CRC screening than uninsured males(AOR, 2.02; 95% CI, 0.96–4.23)

For females, there was no effect of insurance coverage (AOR, 0.86; 95% CI; 0.34–1.93)
Koroukin et al., 2006138

Cross-sectional, national Medicare Denominator File, 1999, ≥65 years

N = 23 million (2.5 million duals, 20.2 million nonduals)

Assess disparities in CRC screening between elderly dual Medicare-Medicaid enrollees (duals) and non-duals.Any test code (colonoscopy, FS, FOBT) within the past year (claims)Insurance status: Medicare dual eligible vs. non dual-eligibleDual beneficiary status, age, race, sex↓ dual-eligiblesUse of CRC screening services decrease if dual enrollment in Medicare-Medicaid: FOBT (AOR, 0.48; 95% CI, 0.45–0.51), FS (AOR, 0.55; 95% CI, 0.49–0.61), FS or colonoscopy (AOR, 0.60; 95% CI, 0.54‐0.67), colonoscopy (AOR, 0.85; 95% CI, 0.80‐0.89)
Schneider et al., 2008124

Cross-sectional, retrospective, national

Medicare Current Beneficiary Survey, 2000,≥ 65 years

N = 10,173

Assessed whether beneficiaries in MMC plans were more likely than those in traditional FFS insurance to receive CRC screening and whether type of insurance was associated with use of specific screening strategiesAny test (2 years for FOBT or 5 years for colonoscopy or FS) (self-report)Insurance status categories: MMC; FFS SUPP; FFS NO SUPPAge, gender, race, Hispanic origin, education, marital status, annual income, metro area residencyMMCMMC (52.9%) was more likely than supplemental insurance groups(FFS SUP) (50.7%, P = 0.15) to receive CRC screening, but time-interval appropriateness was similar between groups (no confidence intervals provided)

Beneficiaries in MMC were more likely than those in the FFS SUPP group to receive interval- appropriate FOBT (36.3% vs. 32.1%; P = 0.013), but less likely to receive an interval- appropriate invasive screening procedure (35.9% vs. 40.8%; P < 0.001)
Trivers, et al., 2008113

Cross-sectional, retrospective, national

NHIS, 2000 compared with 2005, 50–64 years

N = 6,020 in 2000; 6,706 in 2005

Determine whether progress was made between 2000 and 2005 in reducing CRC screening disparities by race, ethnicity, income, and insurance status.Any test (FOBT within past year, FS or colonoscopy in past 10 years) (self‐report)Insurance status categories; public, private, or noneAge, gender, race, ethnicity, poverty ratio, insurance, education, region, years in US↑ private health insuranceFor both males and females with private insurance, there was a significant increase in screening from 2000 to 2005 (change over time for male: OR, 6.7; 95% CI, 3.4–9.9 and for female: OR, 10.0; 95% CI, 7.0–13.0)

For females with no insurance, there was no change from 2000 to 2005 in screening rates (AOR, −1.3; 95% CI, −7.1–4.6) and for male, there was only a slight increase in screening over time (AOR, 3.0; 95% CI, −3.9 to 9.8)
Thorpe, et al., 2005114

Cross-sectional, retrospective, local

Community Health Survey, 2003, New York City residents, ≥ 50 years

N = 3,606

Analysis of individual-and neighbor- hood-level factors associated with colon cancer screening practicesAny test (colonoscopy in past 10 years, FOBT in past year, and FS in past 5 years) (self-report)Insurance statusAge, race, birthplace, gender, education, household income, neighborhood income↓ uninsuredAny timely CRC screening test: Medicaid or Medicare (AOR 1.02; 95% CI, 0.81–1.28); uninsured (AOR 0.31; 95% CI, 0.20‐ 0.48)

Colonoscopy in past 10 years: Medicaid or Medicare (AOR 0.89; 95% CI, 0.71‐ 1.13); uninsured (AOR 0.39; 95% CI, 0.23–0.65)
Zapka et al., 2002107

Cross-sectional, state

Community Health Survey, 1998, Massachusetts residents,≥ 50 years

N = 1,002

Assess the role of insurance status, type of plan, frequency of preventive health visits, and provider recommendation on utilization of CRC screening testsAny test (colonoscopy or barium enema within 10 years, FS within 5 years, and FOBT in the past year) (self-report)Insurance status categories: for those 50–64 years-- private (non-HMO); HMO; public, uninsured; For those 65+- non‐ HMO Medicare; Medicare HMO; dualsGender, race, education, employment status, income, marital status, family history of CRC, perceived health status↑Medicare non-HMO participantsMedicare HMO participants were somewhat more likely to be currently tested than Medicare non-HMO participants (AOR, 1.83; 95% CI, 0.91– 3.71)

There was an interaction between insurance status and respondents who believed their insurance did, or did not pay for CRC tests

AOR, adjusted odds ratio; BRFSS, Behavioral Risk Factor Surveillance System; CI, confidence interval; CRC, colorectal cancer; FFS, fee-for‐service; FFS + NO SUPP, fee-for-service Medicare + no supplemental insurance; FFS + SUPP, fee-for-service Medicare + supplemental insurance; FOBT, fecal occult blood test; FS, flexible sigmoidoscopy; HINTS, Health Information National Trends Survey; HMO, health maintenance organization; MMC, Medicare managed care; N, number; RR, relative risk.


Arrow symbols (↓ or ↑) are provided as a quick reference point of overall findings and represent the association reported between each variable and CRC screening.

From: 4, Results

Cover of Enhancing the Use and Quality of Colorectal Cancer Screening
Enhancing the Use and Quality of Colorectal Cancer Screening.
Evidence Reports/Technology Assessments, No. 190.
Holden DJ, Harris R, Porterfield DS, et al.

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