br From to UTD and recent CRC screening was similar
From 2012 to 2016, UTD and recent CRC screening was similar among low-income adults aged 65−75 years in each expansion group (Appendix Table 5, available online). Between 2006 and 2010 among low-income adults aged 50−64 years, receipt of endoscopy in the past 10 years or past-year stool testing grew significantly in early states only. During this GSK126 time, recent CRC testing increased by 6.3% in VE, with an aDD of 7.7% (p=0.002) (Appendix Table 6, available online).
Among low-income women aged 65−74 years, BC screening remained stable in each expansion group between 2012 and 2016 (Appendix Table 5, available online). Between 2006 and 2010, BC screening increased significantly by 10.6% and 3.7% among low-income women aged 50−64 years in VE and early states (Appen-dix Table 6, available online).
Characteristics Very earlya Earlyb Latec Not expandingd p-valuee Men and women aged 50−64 yearsf
Note: Boldface indicates statistical significance (p<0.05). aIncludes respondents from Minnesota, Connecticut, District of Columbia, California, Washington, and New Jersey.
bIncludes respondents from Arizona, Arkansas, Colorado, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Nevada, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, Vermont, West Virginia, Michigan, and New Hampshire. cIncludes respondents from Pennsylvania, Indiana, Alaska, Montana, and Louisiana. dIncludes respondents from Alabama, Florida, Georgia, Idaho, Kansas, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Car-olina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming. ep-Value compares differences across the four Medicaid expansion groups using x2 tests. fMen and women missing colorectal cancer screening data were not included. Low-income defined as a household income <$25,000. gWomen missing breast cancer screening data were not included. Low-income defined as a household income <$25,000. BRFSS, Behavioral Risk Factor Surveillance System; NH, non-Hispanic.
In this large population-based study, increases in recent CRC screening prevalence were greater in magnitude among low-income adults aged 50−64 years residing in the six VE expansion states compared with non-expan-sion states. Growth in CRC screening prevalence among
these VE expansion states was not immediate and changes in CRC screening among those expanding Med-icaid later were comparable to non-expansion states. BC screening increased only modestly among low-income women residing in expansion states.
The larger improvements in CRC screening among the residents VE expansion states could be a result of
Figure 1. Crude colorectal and breast cancer screening among low-income adults aged 50−64 years by Medicaid expansion sta-tus, and year, BRFSS 2012, 2014, and 2016.a aLow-income defined as self-reported household income of <$25,000. bUp-to-date colorectal cancer screening: colonoscopy in the past 10 years, sigmoidoscopy in the past 5 years, and/or stool testing in the past year.
BRFSS, Behavioral Risk Factor Surveillance System.
increased insurance coverage through Medicaid, as hav-ing insurance is a strong predictor of CRC screening.28,29 The current study aligns with findings from Oregon’s Medicaid lottery, where low-income residents randomly selected to receive insurance benefits experienced a 10% increase in colonoscopy use compared with controls.30 Four years after Massachusetts extended insurance bene-fits to low-income residents, CRC screening rates were approximately 4% higher than in neighboring states.31 According to a new BRFSS study, recent colonoscopy increased at a faster pace among 27 states expanding Medicaid through 2014 relative to non-expansion states.14 The current findings extend beyond these to show Splicing the increase was confined to the six states expanding Medicaid by 2011. The absence of immediate increases in CRC screening following Medicaid expan-sion may reflect the lag time between people gaining insurance and completing the multistep screening pro-cess that typically relies on a physician visit, followed by a recommendation, and then a follow-up visit with a specialist if a colonoscopy is performed.15 Furthermore, once people obtain insurance, there is pent-up demand to address more-immediate health conditions or symp-toms.32 In line with the current study, others report that improvements in preventive services (e.g., diabetes
screening) were larger 2 years following Medicaid expan-sion than the initial year.8 It is likely that the full impact of Medicaid expansions on cancer screening may not yet be fully visible and the previously reported modest improvements in early stage at diagnosis for screen detectable cancers could progress further.11−13