Adherence to multi-target stool DNA colorectal cancer screening among Medicare patients in Alabama

Colorectal cancer (CRC) incidence and mortality in Alabama are higher than national averages. We assessed adherence to multi-target stool DNA (mt-sDNA) testing and factors associated with adherence among Alabama Medicare enrollees.

Traditional Medicare and Medicare Advantage enrollees aged 65-85 from Alabama who were sent mt-sDNA kits (October 2014-November 2024) were evaluated for mt-sDNA test adherence, defined as return of a valid kit, and time to kit return. Logistic regression analysis was performed to identify demographic factors associated with adherence. Kaplan-Meier analyses and a multivariable Cox proportional hazards model were used to evaluate differences in time to kit return.

Overall, 167,675 individuals were included and 78.6% were adherent to mt-sDNA testing. In adjusted logistic regression analyses, patients aged 76-85 years (odds ratio [OR] = 1.24, 95% confidence interval [CI] = 1.20-1.28, p < 0.001, reference: age = 65-75 years), those insured by traditional Medicare (OR = 1.57, 95% CI = 1.53-1.62, p < 0.001, reference: Medicare Advantage), and those with prior mt-sDNA testing history (OR = 2.09, 95% CI = 2.02-2.16, p < 0.001, reference: new patients) were more likely to return kits. Faster kit return was found among patients receiving full digital outreach compared with no digital outreach (adjusted hazard ratio [aHR] = 1.26, 95% CI = 1.24-1.29) and those with prior mt-sDNA testing history (aHR = 1.32, 95% CI = 1.30-1.34) (log-rank p < 0.0001).

Overall, 78.6% of Alabama Medicare enrollees completed mt-sDNA testing. mt-sDNA adherence rate was higher in all subgroups analyzed compared with national and state averages with all CRC screening modalities combined. Targeted outreach strategies were associated with higher CRC screening completion and may help inform future screening programs.