Folasade P May1,2,3, Elizabeth M Yano4,5, Dawn Provenzale6,7,8, W Neil Steers9,4,10, Donna L Washington9,11,4. 1. Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA. fmay@mednet.ucla.edu. 2. Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases at the University of California Los Angeles, Los Angeles, CA, 90095, USA. fmay@mednet.ucla.edu. 3. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System (Sepulveda Campus), Los Angeles, CA, 91343, USA. fmay@mednet.ucla.edu. 4. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System (Sepulveda Campus), Los Angeles, CA, 91343, USA. 5. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA. 6. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA. 7. Department of Medicine, Duke University Medical Center, Durham, NC, USA. 8. Department of Veterans Affairs Cooperative Studies Coordinating Center, Durham, NC, USA. 9. Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA. 10. Division of General Internal Medicine and Health Services Research, Department of Medicine at the University of California Los Angeles, Los Angeles, CA, 90024, USA. 11. Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases at the University of California Los Angeles, Los Angeles, CA, 90095, USA.
Abstract
BACKGROUND: Colorectal cancer (CRC) is a deadly but largely preventable disease. Screening improves outcomes, but screening rates vary across healthcare coverage models. In the Veterans Health Administration (VA), screening rates are high; however, it is unknown how CRC screening rates compare for Veterans with other types of healthcare coverage. AIMS: To determine whether Veterans with Veteran-status-related coverage (VA, military, TRICARE) have higher rates of CRC screening than Veterans with alternate sources of healthcare coverage. METHODS: We conducted a cross-sectional analysis of Veterans 50-75 years from the 2014 Behavioral Risk Factor Surveillance System survey. We examined CRC screening rates and screening modalities. We performed multivariable logistic regression to identify the role of coverage type, demographics, and clinical factors on screening status. RESULTS: The cohort included 22,138 Veterans. Of these, 76.7% reported up-to-date screening. Colonoscopy was the most common screening modality (83.7%). Screening rates were highest among Veterans with Veteran-status-related coverage (82.3%), as was stool-based screening (10.8%). The adjusted odds of up-to-date screening among Veterans with Veteran-status-related coverage were 83% higher than among Veterans with private coverage (adjusted OR = 1.83, 95% CI = 1.52-2.22). Additional predictors of screening included older age, black race, high income, access to medical care, frequent medical visits, and employed or married status. CONCLUSIONS: CRC screening rates were highest among Veterans with Veteran-status-related coverage. High CRC screening rates among US Veterans may be related to system-level characteristics of VA and military care. Insight to these system-level characteristics may inform mechanisms to improve CRC screening in non-VA settings.
BACKGROUND:Colorectal cancer (CRC) is a deadly but largely preventable disease. Screening improves outcomes, but screening rates vary across healthcare coverage models. In the Veterans Health Administration (VA), screening rates are high; however, it is unknown how CRC screening rates compare for Veterans with other types of healthcare coverage. AIMS: To determine whether Veterans with Veteran-status-related coverage (VA, military, TRICARE) have higher rates of CRC screening than Veterans with alternate sources of healthcare coverage. METHODS: We conducted a cross-sectional analysis of Veterans 50-75 years from the 2014 Behavioral Risk Factor Surveillance System survey. We examined CRC screening rates and screening modalities. We performed multivariable logistic regression to identify the role of coverage type, demographics, and clinical factors on screening status. RESULTS: The cohort included 22,138 Veterans. Of these, 76.7% reported up-to-date screening. Colonoscopy was the most common screening modality (83.7%). Screening rates were highest among Veterans with Veteran-status-related coverage (82.3%), as was stool-based screening (10.8%). The adjusted odds of up-to-date screening among Veterans with Veteran-status-related coverage were 83% higher than among Veterans with private coverage (adjusted OR = 1.83, 95% CI = 1.52-2.22). Additional predictors of screening included older age, black race, high income, access to medical care, frequent medical visits, and employed or married status. CONCLUSIONS: CRC screening rates were highest among Veterans with Veteran-status-related coverage. High CRC screening rates among US Veterans may be related to system-level characteristics of VA and military care. Insight to these system-level characteristics may inform mechanisms to improve CRC screening in non-VA settings.
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