Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Sep 5, 2018; 9(4): 31-38
Published online Sep 5, 2018. doi: 10.4292/wjgpt.v9.i4.31
Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?
Abhilash Perisetti, Hafiz Khan, Nayana E George, Rachana Yendala, Aamrin Rafiq, Summre Blakely, Drew Rasmussen, Nathan Villalpando, Hemant Goyal
Abhilash Perisetti, Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Hafiz Khan, Drew Rasmussen, Nathan Villalpando, Department of Public Health, Texas Tech University Health Sciences, Lubbock, TX 79430, United States
Nayana E George, Department of Internal Medicine, University of Arkansas Medical Sciences, Little Rock, AR 72205, United States
Rachana Yendala, Department of Hematology and Oncology, Texas Tech University Health Sciences, Lubbock, TX 79430, United States
Aamrin Rafiq, Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, United States
Summre Blakely, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
Hemant Goyal, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31201, United States
Author contributions: All authors contributed to this paper.
Institutional review board statement: Since this study was performed from a publicly accessible database with non-identifying and anonymous information, there was no need for institutional review board approval.
Informed consent statement: Informed consent was not needed in this database study because of the non-identifying and anonymous nature of the database.
Conflict-of-interest statement: All authors confirm that there are no financially relevant conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hemant Goyal, FACP, MD, Assistant Professor, Department of Internal Medicine, Mercer University School of Medicine, 707 Pine St., Macon, GA 31201, United States. doc.hemant@yahoo.com
Telephone: +1-478-3015862 Fax: +1-478-3015841
Received: June 1, 2018
Peer-review started: June 1, 2018
First decision: July 9, 2018
Revised: August 20, 2018
Accepted: August 26, 2018
Article in press: August 27, 2018
Published online: September 5, 2018
AIM
To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients.
METHODS
Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios (aORs), and 95%CIs using SAS v9.3 software.
RESULTS
Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64 (P < 0.0001), Non-Hispanic Whites (P < 0.0001), and those with a primary care physician (P < 0.0001) among other factors. Adjusting for possible confounders, aORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year aOR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year aOR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year aOR = 0.91; 95%CI: 0.81-1.02.
CONCLUSION
We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer (CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.
Core tip: There is scarcity of data about role of “out-of-pocket costs” among insured patients. From a prospectively collected database of more than 200000 insured individuals, we found that almost 9% of the population could not see a doctor due to an out-of-pocket cost issue. This occurrence was significantly higher in African- Americans, and those without primary care physicians. Undergoing the stool occult blood test, sigmoidoscopy, or colonoscopy in past one-year was significantly associated with not following up with a physician because of cost. The results of our study show that limited financial resources are significantly associated with colorectal cancer non-screening in the insured Americans.
