Colorectal cancer screening for ‘vulnerable’ patients higher in Medicaid expansion states
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CHICAGO — Colorectal cancer screening rates at federally qualified health centers were significantly higher in states that expanded Medicaid under the Affordable Care Act vs. states that did not, according to data at Digestive Disease Week.
“Federally qualified health centers are a relatively new place for people to get primary care, since the Affordable Care Act started funding them in 2012,” Megan R. McLeod, MD, MSc, from the David Geffen School of Medicine at University of California, Los Angeles, told Healio. “This is a population that traditionally has been medically underserved, and while the government and other groups monitor different quality measures, patterns in colorectal cancer screening are fairly understudied in this setting.”
To examine the impact of state Medicaid expansion on CRC screening rates in federally qualified health centers, McLeod and colleagues conducted a cross-sectional analysis of screening rates and predictors of screening in Medicaid expansion states vs. non-expansion states using national data from the 2021 Uniform Data Systems.
The researchers obtained CRC screening rates for patients aged 50 to 74 years (n = 6,940,879) at U.S. federal health centers (n = 1,284) in each state and used chi-square tests and Wilcoxon rank sum tests to evaluate patient-mix characteristics based on Medicaid expansion status. Additionally, McLeod and colleagues conducted mixed-effects linear regression models to assess which characteristics predicted high and low CRC screening participation in federal health centers in Medicaid expansion states and in non-expansion states.
“Colorectal cancer screening rates are higher at these community health centers if they are located within a Medicaid expansion state vs. non-expansion states,” McLeod said.
The researchers reported that the median CRC screening rate among all federal health centers in 2021 was 40.8%, with screening rates significantly higher among federal health centers in Medicaid expansion states (42.1%) compared with non-expansion states (36.5%, P ≤ .0001).
“If you take a closer look at different organization-level characteristics that predict their screening rates, the patterns are very different,” McLeod told Healio. “In non-Medicaid expansion states, the largest negative predictive factor for colorectal cancer screening is whether patients have insurance. [However,] among community health centers in Medicaid expansion states, many different things predict screening uptake, including patient income, patient race, even the language that the patients speak.”
She added: “I think this points to the fact that, in Medicaid expansion states, vulnerable populations have an additional barrier removed for their screening.”
The researchers also found that, in the adjusted model for non-Medicaid expansion states, federal health centers in rural settings or centers with a high proportion of uninsured patients demonstrated a significantly higher likelihood for poor CRC screening rates.
Comparatively, federal health centers in Medicaid expansion states exhibited significantly lower CRC screening rates if the center catered to large proportions of male, Black, Hispanic, low-income, homeless or uninsured patients.
“The big takeaway from this study is that having insurance available to patients is obviously going to greatly impact their health care utilization, including preventive care,” McLeod told Healio. “Policymakers should work toward making insurance as available as possible to patients, and ensure that these centers have the resources they need to identify specific patient populations at risk for worse cancer-related outcomes or not getting screening in the first place.”
She added that gastroenterology providers should acknowledge the wide range of factors “that influence a patient’s decision about whether they should undergo screening and keep those in mind when they are reaching out to patients to loop them into their screening services.”
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McLeod MR, et al. Abstract 31: Impact of state Medicaid expansion status on colorectal cancer screening rates and predictors of screening at U.S. federally qualified health centers. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago (hybrid).
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