KEY TAKEAWAYS
- The study aimed to investigate the impact of physician supply and health insurance coverage on CRC screening rates across a state-wide population.
- Researchers found that expanding insurance coverage, not physician density, more effectively improves CRC screening rates.
Colorectal cancer (CRC) is the 2 leading cause of cancer death in US adults but can be reduced by screening. The roles of individual and contextual factors, and especially physician supply, in attaining universal CRC screening remain uncertain.
Jennifer E Bayly and the team aimed to assess the impact of physician density and health insurance coverage on CRC screening rates across a state-wide population. Using a representative analysis, they evaluated how these factors influenced screening participation.
They performed an inclusive analysis using data from adults aged 50-75 years who participated in the 2018 New York (NY) Behavioral Risk Factor Surveillance System, linked to county-level covariates such as primary care physician (PCP) density and gastroenterologist (GI) density. Data were analyzed in 2023-2024.
The analysis included ecological and geospatial evaluations of county-level CRC screening prevalence and individual-level Poisson regression models assessing screening receipt, adjusted for socioeconomic and county-level contextual variables.
About 71% (95% CI 70% to 73%) of adults were up-to-date with CRC screening across New York’s 62 counties. County-level CRC screening showed significant spatial patterning (Global Moran’s I=0.14, P=0.04), indicating the influence of county-level contextual factors. Lack of health insurance was associated with a lower likelihood of up-to-date screening (ß=-1.09 (95% CI -2.00 to -0.19); adjusted prevalence ratio 0.68 (95% CI 0.60 to 0.77)), even when accounting for age, race/ethnicity, and education.
The county-level densities of both PCPs and GIs were not associated with screening at either the county or individual level. Other individual-level determinants of screening included education status and age.
The study concluded that physician density was completely unassociated with CRC screening, while health insurance status was strongly related. In similar screening environments, broadened insurance coverage for CRC screening is likely to improve screening rates far more effectively than increased physician supply.
The study was funded by the National Institute on Aging, Health Resources and Services Administration.
Source: https://pubmed.ncbi.nlm.nih.gov/39029926/
Bayly JE, Schonberg MA, Castro MC, et al. (2024). “Individual and geospatial factors associated with receipt of colorectal cancer screening: a state-wide mixed-level analysis.” Fam Med Community Health. 2024 Jul 18;12(Suppl 2):e002983. doi: 10.1136/fmch-2024-002983. PMID: 39029926.
