Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Sep 5, 2018; 9(4): 31-38
Published online Sep 5, 2018. doi: 10.4292/wjgpt.v9.i4.31
Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?
Abhilash Perisetti, Hafiz Khan, Nayana E George, Rachana Yendala, Aamrin Rafiq, Summre Blakely, Drew Rasmussen, Nathan Villalpando, Hemant Goyal
Abhilash Perisetti, Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Hafiz Khan, Drew Rasmussen, Nathan Villalpando, Department of Public Health, Texas Tech University Health Sciences, Lubbock, TX 79430, United States
Nayana E George, Department of Internal Medicine, University of Arkansas Medical Sciences, Little Rock, AR 72205, United States
Rachana Yendala, Department of Hematology and Oncology, Texas Tech University Health Sciences, Lubbock, TX 79430, United States
Aamrin Rafiq, Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, United States
Summre Blakely, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
Hemant Goyal, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31201, United States
Author contributions: All authors contributed to this paper.
Institutional review board statement: Since this study was performed from a publicly accessible database with non-identifying and anonymous information, there was no need for institutional review board approval.
Informed consent statement: Informed consent was not needed in this database study because of the non-identifying and anonymous nature of the database.
Conflict-of-interest statement: All authors confirm that there are no financially relevant conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hemant Goyal, FACP, MD, Assistant Professor, Department of Internal Medicine, Mercer University School of Medicine, 707 Pine St., Macon, GA 31201, United States. doc.hemant@yahoo.com
Telephone: +1-478-3015862 Fax: +1-478-3015841
Received: June 1, 2018
Peer-review started: June 1, 2018
First decision: July 9, 2018
Revised: August 20, 2018
Accepted: August 26, 2018
Article in press: August 27, 2018
Published online: September 5, 2018
ARTICLE HIGHLIGHTS
Research background
Over the past decade, intense research has been focused on predictors of colorectal cancer (CRC) screening to improve the screening rates. Availability of health insurance, the level of income, educational status, and access to a personal doctor, obesity, and race were found to be significant predictors of CRC non-screening rates in the past. Though uninsured individuals are at high-risk for non-screening, studies related to the barriers to CRC screening among insured individuals are scarce.
Research motivation
There is only limited information if out-of-pocket cost restraints in the insured population affect the receipt of coloscopy for CRC screening.
Research objectives
The main objective was to investigate if out-of-pocket cost restraint plays a part in not getting the screening colonoscopy.
Research methods
The study was performed from a prospectively collected telephone database named Behavioral Risk Factor Surveillance System (BRFSS) (2012) included 215,436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios (aORs), and 95%CIs using SAS v9.3 software.
Research results
Nine percent of the insured population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64 (P < 0.0001), Non-Hispanic Whites (P < 0.0001), and those with a primary care physician (P < 0.0001) among other factors. Adjusting for possible confounders, aORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year aOR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year aOR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year aOR = 0.91; 95%CI: 0.81-1.02.
Research conclusions
Out-of-pocket cost is a barrier to the receipt of colonoscopy in the insured population.
Research perspectives
Further steps should be taken to target the insured population to increase the colon cancer screening.
