Published online Sep 5, 2018. doi: 10.4292/wjgpt.v9.i4.31
Peer-review started: June 1, 2018
First decision: July 9, 2018
Revised: August 20, 2018
Accepted: August 26, 2018
Article in press: August 27, 2018
Published online: September 5, 2018
Processing time: 96 Days and 15.6 Hours
To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients.
Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios (aORs), and 95%CIs using SAS v9.3 software.
Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64 (P < 0.0001), Non-Hispanic Whites (P < 0.0001), and those with a primary care physician (P < 0.0001) among other factors. Adjusting for possible confounders, aORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year aOR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year aOR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year aOR = 0.91; 95%CI: 0.81-1.02.
We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer (CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.
Core tip: There is scarcity of data about role of “out-of-pocket costs” among insured patients. From a prospectively collected database of more than 200000 insured individuals, we found that almost 9% of the population could not see a doctor due to an out-of-pocket cost issue. This occurrence was significantly higher in African- Americans, and those without primary care physicians. Undergoing the stool occult blood test, sigmoidoscopy, or colonoscopy in past one-year was significantly associated with not following up with a physician because of cost. The results of our study show that limited financial resources are significantly associated with colorectal cancer non-screening in the insured Americans.