Abstract 3341: Rural and urban disparities in colonoscopy use persisted despite cost-sharing reduction among Medicare beneficiaries

Abstract

Abstract Background: Due to passage of the Patient Protection and Affordable Care Act (ACA), Medicare began waiving Part B deductibles and eliminating coinsurance for all colonoscopies in 2011. As rural populations have significantly lower income than urban, there is hope the cost reduction would decrease rural screening disparities. We thus examined rural-urban colonoscopy use pre-/post-ACA implementation. Methods: We used Behavioral Risk Factor Surveillance System data (2008-2016) to examine colonoscopy utilization for two years pre-ACA (2008 and 2010) and three years post-ACA (2012, 2014, and 2016) with stratification by rural/urban residence. Multivariate logistic regression was used to examine the differences in screening likelihood across rural and urban groups, while controlling for other factors such as age, sex, marital status, race/ethnicity, household income, educational attainment, gastroenterologist availability, exercise, smoking, and years. Results: Of the 302,941 eligible Medicare beneficiaries, 203,426 (67.2%) received a colonoscopy. Colonoscopy receipt increased from 62.8% pre-ACA to 70.2% post-ACA years (p<.001). Across rural-urban areas, we found a significant increase in the receipt of colonoscopy from pre- to post-ACA (p<.001). The receipt of colonoscopy was higher among urban residents (69.2%) compared to rural residents (63.5%, p<.001). After adjusting for covariates, urban residents were more likely to receive colonoscopy both pre-ACA (OR=1.11, 95% CI: 1.06-1.15) and post-ACA (OR=1.11, 95% CI: 1.06-1.16). Conclusions: Despite cost-sharing reduction of Medicare coverage for colonoscopy, rural and urban differences in colonoscopy use persisted over time among Medicare beneficiaries. Although the receipt of colonoscopy increased over time, the gap between rural and urban populations has remained. Colonoscopy Use Before and After Implementation of The ACAPreACAPost ACARuality%OR95%CI%OR95%CIRural59.4166.61Urban64.91.111.061.1572.11.111.061.16 Citation Format: Min Jee Lee, Wiley Jenkins, Eric Adjei Boakye, Sabha Ganai. Rural and urban disparities in colonoscopy use persisted despite cost-sharing reduction among Medicare beneficiaries [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3341.