社会人口学因素和查CT结肠镜在医疗保险受益者中的使用
Eric W Christensen1,2, Pina C Sanelli3,4, Elizabeth Y Rula1
1Economic and Health Services Research, Harvey L. Neiman Health Policy Institute, 1892 Preston White Dr, Reston, VA 20191.
AJR. American journal of roentgenology
|July 19, 2023
概括
医疗保险对CT结肠镜 (CTC) 的覆盖可以减少结肠直肠癌 (CRC) 查方面的差异. 高收入人群比其他方法更有可能使用查CTC.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 医疗成像医学成像
背景情况:
- 结肠直肠癌 (CRC) 查不遵守影响了三分之一的符合条件的美国个人.
- 目前的指导方针提供多种查策略,以改善遵守.
- 医疗保险覆盖大多数CRC查测试,不包括CT结肠镜 (CTC).
研究的目的:
- 为了比较CTC与其他CRC选测试的使用情况.
- 分析查测试使用率与社会经济因素 (收入,种族,种族,城市化) 之间的关联.
- 为了评估医疗保险收费服务受益人群中的这些协会.
主要方法:
- 对5%的医疗保险索赔数据 (2011-2020年) 的回顾性分析.
- 包括45-85岁的个体,不包括高风险的CRC患者.
- 多变量后勤回归模型以评估基于收入,种族,种族和城市化程度的选测试利用率,控制共变量.
主要成果:
- 收入最高阶段 (100万美元以上) 的个人显示,与较低收入群体相比,查CTC的几率比率 (OR) (5.73) 显著更高.
- 使用查CTC显示,与其他CRC查方法相比,种族/种族和城市化差异较小.
- 较高的收入与查CTC利用率比光学结肠镜检查,西格莫视镜检查或便检查更强烈相关.
结论:
- 收入与查CTC利用率的关联性明显大于其他CRC查测试.
- 医疗保险对查CTC的不覆盖可能会加剧CRC查遵守的基于收入的差异.
- 扩大Medicare对查CTC的覆盖范围可能会减轻这些差异,特别是对于那些避免光学结肠镜的人来说.
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