Predictors of endoscopic colorectal cancer screening over time in 11 states

Lee Mobley, Tzy Mey Kuo, Matthew Urato, John Boos, Nancy Lozano-Gracia, Luc Anselin

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objectives We study a cohort of Medicare-insured men and women aged 65+ in the year 2000, who lived in 11 states covered by Surveillance, Epidemiology, and End Results (SEER) cancer registries, to better understand various predictors of endoscopic colorectal cancer (CRC) screening. Methods We use multilevel probit regression on two cross-sectional periods (2000-2002, 2003-2005) and include people diagnosed with breast cancer, CRC, or inflammatory bowel disease (IBD) and a reference sample without cancer. Results Men are not universally more likely to be screened than women, and African Americans, Native Americans, and Hispanics are not universally less likely to be screened than whites. Disparities decrease over time, suggesting that whites were first to take advantage of an expansion in Medicare benefits to cover endoscopic screening for CRC. Higher-risk persons had much higher utilization, while older persons and beneficiaries receiving financial assistance for Part B coverage had lower utilization and the gap widened over time. Conclusions Screening for CRC in our Medicare-insured sample was less than optimal, and reasons varied considerably across states. Negative managed care spillovers were observed, demonstrating that policy interventions to improve screening rates should reflect local market conditions as well as population diversity.

Original languageEnglish (US)
Pages (from-to)445-461
Number of pages17
JournalCancer Causes and Control
Issue number3
StatePublished - Mar 2010


  • Colorectal cancer screening
  • Managed care spillover
  • Socio-ecological model
  • Spatial heterogeneity
  • Spatial interaction
  • Utilization disparities

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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