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Increased primary care usage reduced colorectal cancer incidence, mortality in Medicare beneficiaries
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Medicare beneficiaries who underwent more primary care visits were less likely to develop or die from colorectal cancer in a recent population-based, case-control study.
Researchers evaluated data from Medicare beneficiaries aged 67 to 85 years with colorectal cancer (CRC) diagnosed between 1994 and 2005, along with matched controls representing the at-risk population. The number of primary care physician (PCP) visits between 4 and 27 months before diagnosis, incidence and mortality from CRC, and all-cause mortality, were collected. The cohort included 102,902 matched patients for analysis of CRC incidence (mean age, 76.2 years), 27,080 for CRC mortality (mean age, 76.7 years) and 60,535 for all-cause mortality.
Participants with five to 10 primary care visits had reduced risk for incidence of (adjusted OR=0.94; 95% CI, 0.91-0.96) and mortality from CRC (aOR=0.78; 95% CI, 0.75-0.82), and all-cause mortality (aOR=0.79; 95% CI, 0.76-0.82), compared with patients with one or no visits. The addition of prior CRC screening and polypectomy to analysis eliminated the association between PCP visits and CRC diagnosis (aOR=1; 95% CI, 0.98-1.03) and attenuated the links with CRC-related (aOR=0.86; 95% CI, 0.82-0.9) and all-cause mortality.
These associations were more pronounced among patients diagnosed at a later stage, those with distal lesions, and patients with a more recent diagnosis. Patients with a greater number of PCP visits were more likely to have early-stage diagnosis and proximal lesions.
“This study complements and extends previous evidence of the benefits of primary care in improving health outcomes,” the researchers concluded. “In particular, primary care helps decrease CRC by promoting screening and facilitating referrals for colonoscopy and polypectomy.
“Because a recommendation from primary care is one of the strongest predictors of adherence to CRC screening and several different options are available for CRC screening, access to primary care is important for counseling on these options. Promoting and increasing access to primary care for Medicare beneficiaries may help decrease the national burden of CRC.”
Disclosure: See the study for a full list of relevant financial disclosures.
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