P0245 - Colorectal Cancer Screening Rates and Associated Characteristics Among US Medicare Beneficiaries Aged 66-75 Years Old in 2016-2018

Suying Li, PhD¹, Lesley-Ann Miller-Wilson, PhD, MS, MBA², Haifeng Guo, MS¹, Madison Hoover, MS¹, Deborah A. Fisher, MD, MHS^3
1Chronic Disease Research Group, Minneapolis, MN; ²Exact Sciences, Madison, WI; ³Duke University, Raleigh, NC

Introduction: This study aimed to update incident colorectal cancer (CRC) screening rates in the U.S. Medicare population at average-risk (AR) for CRC and to explore characteristics associated with screening.

Methods: We used the 20% Medicare random sample data to examine a yearly study population, 2016-2018, of Medicare fee-for-service beneficiaries aged 66-75 years at AR for CRC (no history of CRC, colorectal polyps, inflammatory bowel disease, or hereditary CRC syndrome). Screening modalities included colonoscopy, fecal immunochemical test (FIT), guaiac-based fecal occult blood test (gFOBT), and multi-target stool DNA test (mt-sDNA). Tests were identified by Current Procedural Terminology and Healthcare Common Procedure Coding System codes. Characteristics and comorbidities were defined by the previous year. Screening rates were calculated as number of incident screenings per 1,000 Medicare beneficiaries. Overall rates were normalized to 2018 Medicare population distributions of age, sex, and race. Odds ratios (ORs) of incident screening by characteristics were reported for 2018 study cohort.

Results: Each year > 1.4 million AR individuals met the inclusion/exclusion criteria from > 6.5 million Medicare beneficiaries. The overall adjusted incident CRC screening rate per 1,000 Medicare beneficiaries increased from 85.2 in 2016 to 94.3 in 2018 (Figure 1). By modality, incident screening rates decreased 11.4% (22.9 to 20.3) for colonoscopy; decreased 2.4% (58.3 to 56.9) for FIT/gFOBT; and increased 201% (6.5 to 19.6) for mt-sDNA (Figure 1). Compared to individuals who were not screened, those screened were more likely to be female, non-Black race, and to have comorbidities such as hypertension (HTN) and hyperlipidemia (HLD) (Table 1). The OR of incident screening for female was 1.47; referenced to White race, OR was 0.74 for Blacks and 1.16 for Asians; OR was 1.21 and 1.51 for those with HTN and HLD, respectively (Table 1).

Discussion: The incident CRC screening rate in AR Medicare beneficiaries 2016-2018 was low although increasing. The higher prevalence of comorbidities among those who were screened may represent more contact with the healthcare system than among those who were not screened. While prevalence of up-to-date screening status is the usual reported statistic, annual screening incidence better reflects current clinical practices and is more actionable. Our findings suggest more work is needed to improve CRC screening overall and, especially, among male and Black Medicare beneficiaries.


Figure: Incident CRC screening rate in 20% Medicare population at average risk aged 66-75 years

	Screened	Not screened	OR	Lower	Upper
Age group	% distribution
66-69 years	53.25	53.39	1.01	1.00	1.02
70-75 years	46.75	46.61	1.00
Sex	% distribution
Male	37.76	47.76	1.00
Female	62.24	52.24	1.47	1.45	1.49
Race/ethnicity	% distribution
White	83.57	82.48	1.00
Black	6.04	8.01	0.74	0.73	0.76
Asian	2.62	2.13	1.16	1.12	1.20
Hispanic	2.09	1.92	1.13	1.08	1.17
Other	5.68	5.45	1.08	1.05	1.10
Prevalent baseline comorbidity	% of comorbidity
Diabetes	21.56	19.33	0.96	0.94	0.97
Arteriosclerotic heart disease	10.46	10.48	0.83	0.81	0.85
Heart failure	3.82	4.56	0.76	0.74	0.78
Cerebrovascular accidents/transient ischemic attack	3.71	3.88	0.84	0.81	0.86
Cardiac other	13.97	12.87	1.09	1.06	1.12
Anemia	7.03	6.33	0.99	0.97	1.02
Hypertension	49.91	41.54	1.21	1.20	1.23
Hyperlipidemia	44.83	33.85	1.51	1.49	1.53
Chronic kidney disease	12.52	11.61	0.96	0.94	0.98
Cancer (non-skin)	6.41	5.71	1.07	1.05	1.10
Liver disease	1.42	1.25	1.03	0.98	1.08

Table: Table. Demographics and baseline comorbidities by screening status in 2018 Medicare beneficiaries at average-risk aged 66-75 years old


Disclosures:
Suying Li indicated no relevant financial relationships.
Lesley-Ann Miller-Wilson: Exact Sciences – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).
Haifeng Guo indicated no relevant financial relationships.
Madison Hoover indicated no relevant financial relationships.
Deborah Fisher: Eli Lilly – Employee. Exact Sciences – Advisory Committee/Board Member, Consultant, Grant/Research Support. Freenome – Grant/Research Support. Guardant Health – Advisory Committee/Board Member.


Suying Li, PhD¹, Lesley-Ann Miller-Wilson, PhD, MS, MBA², Haifeng Guo, MS¹, Madison Hoover, MS¹, Deborah A. Fisher, MD, MHS³. P0245 - Colorectal Cancer Screening Rates and Associated Characteristics Among US Medicare Beneficiaries Aged 66-75 Years Old in 2016-2018, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.