Abstract
Earlier studies investigated rural-urban colorectal cancer (CRC) screening disparities among older adults or used surveys. The objective was to compare screening uptake between rural and urban individuals 50–64 years of age using private health insurance. Data were analyzed from 58,774 Blue Cross Blue Shield of Nebraska beneficiaries. Logistic regression was used to assess the association between rural-urban and CRC screening use. Results indicate that rural individuals were 56% more likely to use the Fecal Occult Blood Test (FOBT) compared with urban residents, but rural females were 68% less likely to use FOBT. Individuals with few Primary Care Physician (PCP) visits and rural-women are the least to receive screening. To enhance CRC screening, a policy should be devised for the training and placement of female PCP in rural areas. In particular, multilevel interventions, including education, more resources, and policies to increase uptake of colorectal cancer screening, are needed. Further research is warranted to investigate barriers to CRC screening in rural areas.
Highlights
Colorectal cancer (CRC) is ranked the third most common cancer in both women and men of the United States [1, 2]
It presents the eligible population by age, gender, Primary Care Physician (PCP) visits, and Charlson Comorbidity Index (CCI) in 2013 and 2014
The current study hypothesized that Fecal Occult Blood Test (FOBT) use is higher, and colonoscopy use is lower in the rural population and that the urban population would have a higher frequency of PCP visits, and individuals with higher PCP visits will be more likely to receive colorectal cancer (CRC) screening
Summary
Colorectal cancer (CRC) is ranked the third most common cancer in both women and men of the United States [1, 2]. The disease develops as a result of polyp development in the colon; though benign initially, the tumor develops into a malignancy within 10 years [3,4,5]. Past CRC research suggests that screening reduces both the incidence and mortality rate by detecting polyps or tumors at a precancerous stage [6, 7]. For average-risk individuals who are age-eligible for screening (50–75 years old), the “United States Preventive Service Task Force (USPSTF)” recommends the following screening tests: [1] annual high-sensitivity fecal occult blood test (FOBT); [2] sigmoidoscopy every 5 years with a fecal blood test every 3 years; or [3] colonoscopy every 10 years [8]. During 2015, only 62.6% of screen-eligible Americans received one of the recommended screening tests, which is lower than the 80% target set by the “Centers for Disease Control and Prevention’s” Colorectal Cancer Program [9]. Americans 50–64 years old were among the least screened individuals [10]
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