Title: Use of Screening CT Colonography by Age and Race: A Study of Potential Access Barriers Related to Medicare Noncoverage Based on Data From the ACR's National CT Colonography Registry
Country: United States
Age: Adult Only
Sex: All Sexes
Population: Multiple Groups
Care Setting: Outpatient Ambulatory and Primary Care
Clinical Setting: Colorectal Cancer Screening
Data Level: National
Data Type: Disease Registry
Data Source: ACRs National Radiology Data Registry CTC Registry
Conclusion: Disparities In All Minority Groups
Health OutComes Reported: No
Free Text Conclusion: White patients had more CT colonography imaging studies than Black patients by a 12:1 ratio and had higher utilization among ages 65-69, suggesting barriers related to Medicare coverage for racial minorities.
Abstract: Objective: The primary objectives of this investigation were to evaluate the use of screening CT colonography (CTC) examinations by age comparing individuals of Medicare-eligible age to younger cohorts and to determine if the association between use of CTC and Medicare-eligible age varies by race. Although the Affordable Care Act requires commercial insurance coverage of screening CTC, Medicare does not cover screening CTC. Materials and Methods: Using the ACR's CTC registry, the distribution of procedures by age was evaluated using a negative binomial model with patient age (to capture overall trend), indicator of Medicare-eligible age (to capture immediate changes in trend at age 65), and their interaction (to capture gradual changes after age 65) as independent variables. The association between the number of screening CTCs and age was compared by racial identity. Results: The CTC registry contained data on 12,648 screening examinations. Between ages 52 and 64, the number of screening examinations increased; each additional age year was associated with a 5.3% (P < .001) increase in the number of screenings. However, after age 65, the number of screening examinations decreased by -6.9% per additional year of age above 65 compared with the trend between ages 52 and 64 (P < .001). The modal age group for CTC use was 65 to 69 years in white and 55 to 59 in black individuals. Conclusion: After age 65, the number of screening CTC examinations decreased, likely due, at least in part, to lack of Medicare coverage. Medicare noncoverage may have a disproportionate impact on black patients and other racial minorities.