Background: The use of screening colonoscopy among older persons is controversial due to variability in life expectancy and sex-based differences in colorectal cancer incidence. We assessed the relation between sex, age, and receipt of screening colonoscopy overall and within strata of life expectancy.
Methods: We used Medicare data to identify beneficiaries during the years 2001 to 2005 who had not undergone a colonoscopy in the prior 3 years. Medicare claims were used to identify screening colonoscopy use; life expectancy was estimated using a life table approach. We used Poisson regression to examine sex and age differences in screening colonoscopy, adjusted for patient demographic characteristics.
Results: Our sample consisted of 161,229 patients (61.9% female; mean age 76.9 y). The screening colonoscopy rates for females and males were 16.9 and 24.4 screening colonoscopies per 1000 person-years, respectively (P<0.001). The screening colonoscopy rate was highest for patients with the longest life expectancy (10 to 15 y: 27.2 screening colonoscopies per 1000 person-years) compared with 3.4 per 1000 person-years in the life expectancy <5-year group. Within specific life expectancy categories, older patients had significantly lower screening rates; in the 10- to 15-year life expectancy category, patients 75 to 79 years old had a lower rate (21.9 screening colonoscopies per 1000 person-years) than patients 68 to 69 years old (34.1 screening colonoscopies per 1000 person-years; P<0.001).
Conclusions: In a large cohort of Medicare beneficiaries, there was evidence of screening colonoscopy use even among patients with a short life expectancy. After accounting for life expectancy, females and older persons were less likely to undergo screening colonoscopy.
†General Internal Medicine
∥Geriatrics, Yale School of Medicine
‡Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center, New Haven, CT
§Digestive Diseases, University of Illinois College of Medicine, Chicago, IL
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All the authors contributed equally for Role: conception and design of study; analysis of data; drafting and revision of manuscript; and approval of the final manuscript.
Supported by funding from by the Agency for Healthcare Research and Quality (AHRQ: R21 HS017624-01).
The authors declare that they have nothing to disclose.
Reprints: John Gancayco, MD, PSC 80 Box 12877, APO, AP 96367 (e-mail: email@example.com).
Received June 23, 2012
Accepted December 14, 2012