Abstract：
BACKGROUND. Approximately one-third of the eligible U.S. population have not undergone guideline-compliant colorectal cancer (CRC) screening. Guidelines recognize various screening strategies to increase adherence. CMS provides coverage for all recommended screening tests except CT colonography (CTC). OBJECTIVE. The purpose of this study was to compare CTC and other CRC screening tests in terms of associations of utilization with income, race and ethnicity, and urbanicity in Medicare fee-for-service beneficiaries. METHODS. This retrospective study used CMS Research Identifiable Files from January 1, 2011, through December 31, 2020. These files contain claims information for 5% of Medicare fee-for-service beneficiaries. Data were extracted for individuals 45-85 years old, and individuals with high CRC risk were excluded. Multivariable logistic regression models were constructed to determine the likelihood of undergoing CRC screening tests (as well as of undergoing diagnostic CTC, a CMS-covered test with similar physical access as screening CTC) as a function of income, race and ethnicity, and urbanicity while controlling for sex, age, Charlson comorbidity index, U.S. census region, screening year, and related conditions and procedures. RESULTS. For 12,273,363 beneficiary years (mean age, 70.5 ± 8.2 [SD] years; 2,436,849 unique beneficiaries: 6,774,837 female beneficiaries, 5,498,526 male beneficiaries), there were 785,103 CRC screenings events, including 645 for screening CTC. Compared with individuals living in communities with per capita income of less than US$25,000, individuals in communities with income of US$100,000 or more had OR for undergoing screening CTC of 5.73, optical colonoscopy (OC) of 1.36, sigmoidoscopy of 1.03, guaiac fecal occult blood test or fecal immunochemical test of 1.50, stool DNA of 1.43, and diagnostic CTC of 2.00. The OR for undergoing screening CTC was 1.00 for Hispanic individuals and 1.08 for non-Hispanic Black individuals compared with non-Hispanic White individuals. Compared with the OR for undergoing screening CTC for residents of metropolitan areas, the OR was 0.51 for residents of micropolitan areas and 0.65 for residents of small or rural areas. CONCLUSION. The association with income was substantially larger for screening CTC than for other CRC screening tests or for diagnostic CTC. CLINICAL IMPACT. Medicare\'s noncoverage for screening CTC may contribute to lower adherence with CRC screening guidelines for lower-income beneficiaries. Medicare coverage of CTC could reduce income-based disparities for individuals avoiding OC owing to invasiveness, need for anesthesia, or complication risk.
摘要：
背景：大约三分之一的符合条件的美国人群没有接受符合指南的结直肠癌（CRC）筛查。指南承认各种筛查策略，增加坚持。CMS覆盖了所有推荐的筛查测试，除了CT结肠造影（CTC）。目的：比较CTC和其他CRC筛查测试在利用与收入的关联方面，种族和民族,和城市化，在医疗保险按服务收费的受益人中。方法：这项回顾性研究使用2011年1月1日至2020年12月31日的CMS研究可识别文件。这些文件包含5%的Medicare按服务付费受益人的索赔信息。数据提取了45-85岁的个人，排除CRC高风险人群。构建多变量逻辑回归模型以确定接受CRC筛查测试（以及接受诊断性CTC，CMS覆盖的测试，与筛查CTC)作为收入的函数，种族和民族,和城市化，控制性，年龄,Charlson合并症指数,美国人口普查区,筛选年,以及相关的条件和程序。结果：12,273,363个受益年份(平均年龄，70.5±8.2岁；6,774,837名女性，5,498,526名男性；2,436,849名独特受益人），有785,103个CRC筛查事件，包括用于筛查CTC的645。与生活在人均收入<$25,000的社区中的个人相比，收入≥$100,000的社区中的个人进行CTC筛查的OR为5.73，光学结肠镜检查为1.36，乙状结肠镜检查为1.03，愈创木胶粪便潜血试验/粪便免疫化学试验为1.50，粪便DNA为1.43，CTC诊断为2.00。与非西班牙裔白人相比，在接受筛查的CTC中，西班牙裔个体为1.00，非西班牙裔黑人个体为1.08。与大都市地区的居民相比，接受CTC筛查的OR对于小城市地区的居民为0.51，对于小地区或农村地区的居民为0.65。结论：CTC筛查与收入的关联明显大于其他CRC筛查或诊断性CTC。临床影响：医疗保险对CTC筛查的未覆盖可能导致低收入受益人对筛查指南的依从性降低。CTC的医疗保险覆盖范围可以减少由于侵入性而避免光学结肠镜检查的个人的收入差距，需要麻醉，或并发症的风险。
