The impact of travel time on colorectal cancer stage at diagnosis in a privately insured population.
Colonoscopy
Colorectal Neoplasms
/ diagnosis
Early Detection of Cancer
/ statistics & numerical data
Female
Humans
Insurance, Health
Logistic Models
Male
Middle Aged
Neoplasm Staging
Patient Acceptance of Health Care
/ statistics & numerical data
Preventive Health Services
/ statistics & numerical data
Retrospective Studies
Rural Population
Time Factors
Travel
Access to care
Colorectal cancer
Geography
Health services research
Private insurance
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
18 Mar 2019
18 Mar 2019
Historique:
received:
17
08
2018
accepted:
12
03
2019
entrez:
20
3
2019
pubmed:
20
3
2019
medline:
11
5
2019
Statut:
epublish
Résumé
Rural residents are less likely to receive screening for colorectal cancer (CRC) than urban residents. However, the mechanisms underlying this disparity, especially among people aged 50-64 years old with private health insurance, are not well understood. We examined the impact of travel time on stage at CRC diagnosis. This retrospective cohort study used data from the Blue Cross and Blue Shield of Nebraska. Members of this private insurance company aged 50-64 years, diagnosed with CRC during the period 2012-2016, and continuously enrolled in the insurance plan for at least 6 months prior to CRC diagnosis, were selected for this study. Using Google Maps, we estimated patients' travel time from their home ZIP code to the ZIP code of their colonoscopy provider. Using logistic regression, we analyzed the association between stage at CRC diagnosis, travel time, use of preventive services (i.e., check-ups or counseling to prevent or detect illness at an early stage) and patient characteristics. A total of 307 subjects met the inclusion criteria. People who had not used preventive services 6 months prior to CRC diagnosis had 2.80 (95% CI, 1.00-7.90) times the odds of metastatic CRC compared to those who had used these services. No statistically significant association was found between travel time and metastatic CRC diagnosis (P = 0.99; 95% CI, 0.98-1.01). The fact that 13% of the study population presented with metastatic CRC suggests some noncompliance with preventive services such as screening guidelines. To increase screening uptake and reduce metastatic cases, employers should offer incentives for their employees to make use of preventive services such as CRC screening.
Sections du résumé
BACKGROUND
BACKGROUND
Rural residents are less likely to receive screening for colorectal cancer (CRC) than urban residents. However, the mechanisms underlying this disparity, especially among people aged 50-64 years old with private health insurance, are not well understood. We examined the impact of travel time on stage at CRC diagnosis.
METHODS
METHODS
This retrospective cohort study used data from the Blue Cross and Blue Shield of Nebraska. Members of this private insurance company aged 50-64 years, diagnosed with CRC during the period 2012-2016, and continuously enrolled in the insurance plan for at least 6 months prior to CRC diagnosis, were selected for this study. Using Google Maps, we estimated patients' travel time from their home ZIP code to the ZIP code of their colonoscopy provider. Using logistic regression, we analyzed the association between stage at CRC diagnosis, travel time, use of preventive services (i.e., check-ups or counseling to prevent or detect illness at an early stage) and patient characteristics.
RESULTS
RESULTS
A total of 307 subjects met the inclusion criteria. People who had not used preventive services 6 months prior to CRC diagnosis had 2.80 (95% CI, 1.00-7.90) times the odds of metastatic CRC compared to those who had used these services. No statistically significant association was found between travel time and metastatic CRC diagnosis (P = 0.99; 95% CI, 0.98-1.01).
CONCLUSIONS
CONCLUSIONS
The fact that 13% of the study population presented with metastatic CRC suggests some noncompliance with preventive services such as screening guidelines. To increase screening uptake and reduce metastatic cases, employers should offer incentives for their employees to make use of preventive services such as CRC screening.
Identifiants
pubmed: 30885199
doi: 10.1186/s12913-019-4004-6
pii: 10.1186/s12913-019-4004-6
pmc: PMC6423832
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
172Subventions
Organisme : NCI NIH HHS
ID : P30 CA086862
Pays : United States
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