Carrie N Klabunde1, Yingye Zheng2, Virginia P Quinn3, Elisabeth F Beaber2, Carolyn M Rutter4, Ethan A Halm5, Jessica Chubak6, Chyke A Doubeni7, Jennifer S Haas8, Aruna Kamineni6, Marilyn M Schapira9, Pamela M Vacek10, Michael P Garcia2, Douglas A Corley11. 1. Office of Disease Prevention, Office of the Director, NIH, Rockville, Maryland. Electronic address: klabundc@od.nih.gov. 2. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. 3. Kaiser Permanente Southern California, Research and Evaluation, Pasadena, California. 4. RAND Corporation, Santa Monica, California. 5. Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas. 6. Group Health Research Institute, Seattle, Washington. 7. Department of Family Medicine and Community Health and Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 8. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 9. Department of Medicine, Perelman School of Medicine, University of Pennsylvania and the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania. 10. Medical Biostatistics Unit, University of Vermont College of Medicine, Burlington, Vermont. 11. Kaiser Permanente Division of Research, Oakland, California.
Abstract
INTRODUCTION: Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings. METHODS: A population-based, longitudinal cohort study was conducted among health plan members aged 65-89 years enrolled during 2011-2012 in three integrated healthcare systems participating in the Population-Based Research Optimizing Screening through Personalized Regimens consortium. Comorbidity measurements used the Charlson index. Analyses, conducted in 2015, comprised descriptive statistics and multivariable modeling that estimated age by comorbidity-specific percentages of patients for two outcomes: colorectal cancer screening uptake and follow-up of abnormal fecal blood tests. RESULTS: Among 846,267 patients, 72% were up-to-date with colorectal cancer screening. Of patients with a positive fecal blood test, 65% received follow-up colonoscopy within 3 months. Likelihood of being up-to-date and receiving timely follow-up was significantly lower for patients aged ≥76 years than their younger counterparts (p<0.001). Comorbidity was less influential than age and more strongly related to timely follow-up than being up-to-date. In all age groups, considerable numbers of patients with no/low comorbidity were not up-to-date or did not receive timely follow-up. CONCLUSIONS: In three integrated healthcare systems, many older, relatively healthy patients were not screening up-to-date, and some relatively young, healthy patients did not receive timely follow-up. Findings suggest a need for re-evaluating age-based screening guidelines and improving screening completion among the elderly. Published by Elsevier Inc.
INTRODUCTION: Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings. METHODS: A population-based, longitudinal cohort study was conducted among health plan members aged 65-89 years enrolled during 2011-2012 in three integrated healthcare systems participating in the Population-Based Research Optimizing Screening through Personalized Regimens consortium. Comorbidity measurements used the Charlson index. Analyses, conducted in 2015, comprised descriptive statistics and multivariable modeling that estimated age by comorbidity-specific percentages of patients for two outcomes: colorectal cancer screening uptake and follow-up of abnormal fecal blood tests. RESULTS: Among 846,267 patients, 72% were up-to-date with colorectal cancer screening. Of patients with a positive fecal blood test, 65% received follow-up colonoscopy within 3 months. Likelihood of being up-to-date and receiving timely follow-up was significantly lower for patients aged ≥76 years than their younger counterparts (p<0.001). Comorbidity was less influential than age and more strongly related to timely follow-up than being up-to-date. In all age groups, considerable numbers of patients with no/low comorbidity were not up-to-date or did not receive timely follow-up. CONCLUSIONS: In three integrated healthcare systems, many older, relatively healthy patients were not screening up-to-date, and some relatively young, healthy patients did not receive timely follow-up. Findings suggest a need for re-evaluating age-based screening guidelines and improving screening completion among the elderly. Published by Elsevier Inc.
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