JAMA network open · 2025
Changes in Colorectal Cancer Screening Modalities Among Insured Individuals.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Siddique Sunny, Wang Rong, May Folasade P, Baum Laura V M, Gross Cary P, Ma Xiaomei
Аннотация
IMPORTANCE: Several colorectal cancer (CRC) screening modalities (eg, colonoscopy, stool-based tests) are currently available. Yet, recent national patterns in screening using these modalities and potential differences across sociodemographic groups remain unclear.
OBJECTIVE: To evaluate possible changes in the use of different CRC screening modalities among average-risk individuals aged 50 to 75 years in the US.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used deidentified claims data from 2017 to 2024. Participants included a dynamic cohort of commercially insured Blue Cross Blue Shield beneficiaries. Data were analyzed from May 1 to June 30, 2025.
EXPOSURES: Invasive and noninvasive CRC screening modalities.
MAIN OUTCOMES AND MEASURES: Changes in screening modality use were compared between the periods preceding the onset of the COVID-19 pandemic (ie, preonset: January 1, 2017, to February 28, 2020) and following the onset of the pandemic (ie, postonset: July 1, 2020, to December 31, 2024). Changes in screening by modality were also evaluated using autoregressive integrated moving average models, adjusting for temporal autocorrelation and seasonality.
RESULTS: In this retrospective cohort study of 24 973 642 distinct beneficiaries (mean [SD] age, 57.36 [4.27] years; 12 789 413 female [51.21%]), the use of colonoscopy (mean [SD], 1.29% [0.09%] to 1.14% [0.07%]; P < .001) and fecal immunochemical test (FIT) decreased between the 2 periods (mean [SD], 0.54% [0.03%] to 0.38% [0.07%]; P < .001). However, stool DNA test use increased (mean [SD], 0.19% [0.13%] to 0.61% [0.16%]; P < .001). Males had higher use of colonoscopy than females (mean [SD], 1.21% [0.07%] vs 1.07% [0.07%]; P < .001), whereas females had higher use of stool DNA test than males (mean [SD], 0.68% [0.16%] vs 0.55% [0.15%]; P < .001) and FIT (mean [SD], 0.43% [0.08%] vs 0.33% [0.05%]; P < .001). Areas with socioeconomic status (SES) in the top 20% had higher use of colonoscopy compared with areas where a marker of SES was in the bottom 20% (mean [SD], 1.37% [0.09%] vs 0.91% [0.06%]; P < .001) and stool DNA test (mean [SD], 0.65% [0.17%] vs 0.48% [0.13%]; P < .001) and lower use of FIT (mean [SD], 0.36% [0.09%] vs 0.48% [0.06%]; P < .001). Metropolitan area residents, compared with nonmetropolitan area residents, more frequently underwent colonoscopy (mean [SD], 1.18% [0.08%] vs 0.97% [0.06%]; P < .001) and FIT (mean [SD], 0.41% [0.08%] vs 0.25% [0.04%]; P < .001); however, their use of stool DNA test were similar (mean [SD], 0.61% [0.16%] vs 0.64% [0.16%]; P = .51).
CONCLUSIONS AND RELEVANCE: Among privately insured individuals, the use of colonoscopy and FIT decreased after the COVID-19 pandemic while stool DNA test use increased, with differences by sex, area-level SES, and metropolitan area residence.
OBJECTIVE: To evaluate possible changes in the use of different CRC screening modalities among average-risk individuals aged 50 to 75 years in the US.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used deidentified claims data from 2017 to 2024. Participants included a dynamic cohort of commercially insured Blue Cross Blue Shield beneficiaries. Data were analyzed from May 1 to June 30, 2025.
EXPOSURES: Invasive and noninvasive CRC screening modalities.
MAIN OUTCOMES AND MEASURES: Changes in screening modality use were compared between the periods preceding the onset of the COVID-19 pandemic (ie, preonset: January 1, 2017, to February 28, 2020) and following the onset of the pandemic (ie, postonset: July 1, 2020, to December 31, 2024). Changes in screening by modality were also evaluated using autoregressive integrated moving average models, adjusting for temporal autocorrelation and seasonality.
RESULTS: In this retrospective cohort study of 24 973 642 distinct beneficiaries (mean [SD] age, 57.36 [4.27] years; 12 789 413 female [51.21%]), the use of colonoscopy (mean [SD], 1.29% [0.09%] to 1.14% [0.07%]; P < .001) and fecal immunochemical test (FIT) decreased between the 2 periods (mean [SD], 0.54% [0.03%] to 0.38% [0.07%]; P < .001). However, stool DNA test use increased (mean [SD], 0.19% [0.13%] to 0.61% [0.16%]; P < .001). Males had higher use of colonoscopy than females (mean [SD], 1.21% [0.07%] vs 1.07% [0.07%]; P < .001), whereas females had higher use of stool DNA test than males (mean [SD], 0.68% [0.16%] vs 0.55% [0.15%]; P < .001) and FIT (mean [SD], 0.43% [0.08%] vs 0.33% [0.05%]; P < .001). Areas with socioeconomic status (SES) in the top 20% had higher use of colonoscopy compared with areas where a marker of SES was in the bottom 20% (mean [SD], 1.37% [0.09%] vs 0.91% [0.06%]; P < .001) and stool DNA test (mean [SD], 0.65% [0.17%] vs 0.48% [0.13%]; P < .001) and lower use of FIT (mean [SD], 0.36% [0.09%] vs 0.48% [0.06%]; P < .001). Metropolitan area residents, compared with nonmetropolitan area residents, more frequently underwent colonoscopy (mean [SD], 1.18% [0.08%] vs 0.97% [0.06%]; P < .001) and FIT (mean [SD], 0.41% [0.08%] vs 0.25% [0.04%]; P < .001); however, their use of stool DNA test were similar (mean [SD], 0.61% [0.16%] vs 0.64% [0.16%]; P = .51).
CONCLUSIONS AND RELEVANCE: Among privately insured individuals, the use of colonoscopy and FIT decreased after the COVID-19 pandemic while stool DNA test use increased, with differences by sex, area-level SES, and metropolitan area residence.