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The Association Between Primary Source of Healthcare Coverage and Colorectal Cancer Screening Among US Veterans

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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.

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Abbreviations

CRC:

Colorectal cancer

US:

United States

USPSTF:

United States Preventive Services Task Force

VA:

Veterans Health Administration

EPRP:

External Peer Review Program

NCCR:

National Colorectal Cancer Roundtable

BRFSS:

Behavioral Risk Factor Surveillance System

FIT:

Fecal immunochemical test

FOBT:

Fecal occult blood test

FS:

Flexible sigmoidoscopy

SD:

Standard deviation

CI:

Confidence interval

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Acknowledgment

Dr. Yano was funded through a VA HSR&D Senior Research Career Scientist Award (RCS 05-195).

Author information

Authors and Affiliations

  1. Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA

    Folasade P. May, W. Neil Steers & Donna L. Washington

  2. Department of Medicine, Vatche and Tamar Manoukian Division of Digestive Diseases at the University of California Los Angeles, Los Angeles, CA, 90095, USA

    Folasade P. May & Donna L. Washington

  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

    Folasade P. May, Elizabeth M. Yano, W. Neil Steers & Donna L. Washington

  4. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano

  5. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA

    Dawn Provenzale

  6. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Dawn Provenzale

  7. Department of Veterans Affairs Cooperative Studies Coordinating Center, Durham, NC, USA

    Dawn Provenzale

  8. Division of General Internal Medicine and Health Services Research, Department of Medicine at the University of California Los Angeles, Los Angeles, CA, 90024, USA

    W. Neil Steers

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  1. Folasade P. May
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Corresponding author

Correspondence to Folasade P. May.

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Our study was not sponsored, and we have no conflicts of interest or disclosures to report.

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Disclaimer: The opinions and assertions contained herein are the sole views of the authors and are not to be construed as official or as reflecting the views of the Department of Veteran Affairs or of the United States government.

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May, F.P., Yano, E.M., Provenzale, D. et al. The Association Between Primary Source of Healthcare Coverage and Colorectal Cancer Screening Among US Veterans. Dig Dis Sci 62, 1923–1932 (2017). https://doi.org/10.1007/s10620-017-4607-x

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