Enrollee characteristics and receipt of colorectal cancer testing in Pennsylvania after adoption of the Affordable Care Act Medicaid expansion

Abstract

Abstract Background Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer‐related death in the U.S. Despite increased CRC screening rates, they remain low among low‐income non‐older adults, including Medicaid enrollees who are more likely to be diagnosed at advanced stages. Objectives Given limited evidence regarding CRC screening service use among Medicaid enrollees, we examined multilevel factors associated with CRC testing among Medicaid enrollees in Pennsylvania after Medicaid expansion in 2015. Research Design Using the 2014–2019 Medicaid administrative data, we performed multivariable logistic regression models to assess factors associated with CRC testing, adjusting for enrollment length and primary care services use. Subjects We identified 15,439 adults aged 50–64 years newly enrolled through Medicaid expansion. Measures Outcome measures include receiving any CRC testing and by modality. Results About 32% of our study population received any CRC testing. Significant predictors for any CRC testing include being male, being Hispanic, having any chronic conditions, using primary care services ≤4 times annually, and having a higher county‐level median household income. Being 60–64 years at enrollment, using primary care services >4 times annually, and having higher county‐level unemployment rates were significantly associated with a decreased likelihood of receiving any CRC tests. Conclusions CRC testing rates were low among adults newly enrolled in Medicaid under the Medicaid expansion in Pennsylvania relative to adults with high income. We observed different sets of significant factors associated with CRC testing by modality. Our findings underscore the urgency to tailor strategies by patients' racial, geographic, and clinical conditions for CRC screening.

Keywords

• colorectal cancer
• medicaid administrative data
• medicaid expansion
• Pennsylvania
• screening