Geographic Dispersion and Rural Versus Urban Utilization of CT Colonography in the United States.

Abstract

To assess the geographic dispersion of CT colonography (CTC) as well as differences in CTC utilization in rural versus urban areas in individuals with commercial insurance. Claims data from approximately 18.5 million commercially insured individuals across the United States were used to determine CTC utilization based on geographic area. Geographic areas were defined as metropolitan statistical areas (MSAs) and statewide non-MSAs. Utilization rates per 100,000 covered person-years were calculated for each geographic area for both screening and diagnostic CTC using 2017 data (the most recent full-year data available). Differences in CTC utilization between MSAs (urban) and non-MSAs (rural) were evaluated using weighted multivariate logistic regression. CTC is widely dispersed across the United States with substantial geographic variability. Utilization of screening CTC was considerably lower among individuals residing in rural areas compared with those in urban areas (adjusted odds ratio= 0.353, P= .005). For individuals aged 50 to 64 years, screening CTC utilization was 2.38 per 100,000 in rural areas versus 6.67 per 100,000 in urban areas (P= .005). Utilization of diagnostic CTC was also lower in rural compared with urban areas, though this difference was not statistically significant (8.40 per 100,000 versus 13.11 per 100,000 respectively, P= .070). Although CTC is performed widely across the United States, utilization is generally low and varies substantially based on geographic region. CTC utilization is lower among individuals in rural compared with urban areas.