Copyright
©The Author(s) 2023.
World J Gastrointest Oncol. Sep 15, 2023; 15(9): 1653-1661
Published online Sep 15, 2023. doi: 10.4251/wjgo.v15.i9.1653
Published online Sep 15, 2023. doi: 10.4251/wjgo.v15.i9.1653
Table 1 Demographic variables, n (%)
| All states (n = 893004) | Expansion states (n = 554101) | Non-expansion states (n = 338903) | ||||
| Pre-ACA | Post-ACA | Pre-ACA | Post-ACA | Pre-ACA | Post-ACA | |
| Age (yr) | ||||||
| 50-54 | 144633 (39.15) | 125057 (36.68) | 89366 (39.16) | 78752 (36.63) | 55267 (39.13) | 46305 (36.78) |
| 55-59 | 158010 (31.18) | 145440 (31.86) | 97145 (31.49) | 91564 (32.07) | 60865 (30.61) | 53876 (31.48) |
| 60-64 | 162680 (29.67) | 157184 (31.46) | 99078 (29.35) | 98196 (31.30) | 63602 (30.25) | 58988 (31.74) |
| Gender | ||||||
| Male | 189909 (48.59) | 183869 (48.49) | 117729 (48.72) | 116204 (48.69) | 72180 (48.35) | 67665 (48.13) |
| Race | ||||||
| Non-Hispanic white | 367535 (70.94) | 335133 (69.10) | 227986 (72.30) | 212968 (70.46) | 139549 (68.47) | 122165 (66.67) |
| Non-Hispanic black | 40005 (11.05) | 35498 (11.80) | 21748 (9.64) | 19925 (10.17) | 18257 (13.64) | 15573 (14.73) |
| Other non-Hispanic | 17151 (4.95) | 16381 (5.23) | 11524 (6.16) | 11230 (6.60) | 5627 (2.73) | 5151 (2.78) |
| Multiracial non-Hispanic | 8075 (1.25) | 7433 (1.14) | 5445 (1.36) | 5174 (1.22) | 2630 (1.05) | 2259 (1.01) |
| Hispanic | 26999 (11.80) | 27038 (12.73) | 15400 (10.54) | 15079 (11.56) | 11599 (14.11) | 11959 (14.82) |
| Income | ||||||
| < $25000 | 108872 (26.91) | 90810 (26.19) | 62264 (24.56) | 53270 (24.04) | 46608 (31.27) | 37540 (30.07) |
| Employment status | ||||||
| Employed for wages | 229742 (49.78) | 214339 (50.54) | 143761 (51.16) | 137816 (52.12) | 85981 (47.27) | 76523 (47.70) |
| Self-employed | 51031 (10.74) | 48916 (11.28) | 31149 (10.79) | 30137 (11.23) | 19882 (10.65) | 18779 (11.37) |
| Out of work > 1 yr | 19335 (5.04) | 13208 (3.67) | 12399 (5.18) | 8569 (3.70) | 6936 (4.79) | 4639 (3.62) |
| Out of work < 1 yr | 12272 (3.12) | 9159 (2.50) | 7854 (3.19) | 6055 (2.60) | 4418 (3.01) | 3104 (2.33) |
| Homemaker | 22567 (5.44) | 20059 (5.82) | 12528 (4.99) | 11537 (5.22) | 10039 (6.26) | 8522 (6.06) |
| Student | 1248 (0.28) | 1022 (0.24) | 788 (0.28) | 692 (0.25) | 460 (0.28) | 330 (0.12) |
| Retired | 67400 (12.91) | 60896 (12.66) | 41744 (12.83) | 37970 (12.43) | 25656 (13.05) | 22926 (13.07) |
| Unable to work | 59643 (12.69) | 56912 (13.61) | 33900 (11.58) | 33669 (12.46) | 25743 (14.70) | 23243 (15.65) |
| Education | ||||||
| Some high school or less | 32774 (13.35) | 28992 (13.71) | 18155 (15.34) | 16686 (12.80) | 14619 (15.23) | 12306 (12.32) |
| At least a high school graduate | 431169 (86.65) | 397159 (86.29) | 266416 (84.66) | 250815 (87.20) | 164753 (84.77) | 146344 (87.68) |
Table 2 Difference-in-difference analysis of the three colorectal screening strategies (fobt only, sigmoidoscopy only or colonoscopy only) or at least any colorectal screening, n = 893004
| Screening modality | Percentage point change | Difference-in- difference estimate | P value | |
| Expansion states | Non-expansion states | |||
| Colonoscopy | 16.88 (16.44, 17.32) | 14.49 (13.87, 15.11) | 2.40 (1.64, 3.15) | < 0.001 |
| Sigmoidoscopy | 0.31 (0.20, 0.44) | 0.15 (0.001, 0.280) | 0.17 (-0.01, 0.35) | 0.060 |
| FOBT | 2.52 (2.28, 2.76) | 1.64 (1.35, 1.94) | 0.88 (0.50, 1.26) | < 0.001 |
| CRC screen | 18.34 (17.89, 18.80) | 15.44 (14.80, 16.08) | 2.90 (2.12, 3.69) | < 0.001 |
Table 3 Difference-in-difference analysis comparing utilization of access to colorectal cancer screening services by income - expansion states versus non-expansion
| Annual income | Percentage point change | Difference-in-difference estimate | ||
| Expansion states | Non-expansion states | % | 95%CI | |
| < $25000 | 18.94 | 14.92 | 4.02 | (2.96, 5.07) |
| > $25000 | 19.84 | 16.65 | 3.19 | (1.70, 4.67) |
Table 4 Difference-in-difference analysis comparing utilization of access to colorectal cancer screening in the Medicaid eligible population
| Race/ethnicity | Percentage point change | Difference-in- difference estimate | ||
| Expansion states | Non-expansion states | % | 95%CI | |
| 1Non-Hispanic White | 19.92 | 16.91 | 3.01 | (2.16, 3.85) |
| 1Hispanic | 13.74 | 8.23 | 5.51 | (2.81, 8.20) |
| Non-Hispanic Black | 18.32 | 16.60 | 1.72 | (-0.83, 4.26) |
| Non-Hispanic multiracial | 17.34 | 13.20 | 4.15 | (-2.93, 11.22) |
| Other | 12.39 | 13.93 | -1.54 | (-6.84, 3.76) |
| Education level | ||||
| Some high school or less | 14.63 | 13.42 | 1.59 | (-1.37, 4.55) |
| 1High school grad or more | 18.83 | 15.77 | 4.26 | (3.16, 5.35) |
- Citation: Fletcher G, Culpepper-Morgan J, Genao A, Alatevi E. Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion. World J Gastrointest Oncol 2023; 15(9): 1653-1661
- URL: https://www.wjgnet.com/1948-5204/full/v15/i9/1653.htm
- DOI: https://dx.doi.org/10.4251/wjgo.v15.i9.1653