ASPO Abstracts
Decomposing socio-economic disparity in the use of colonoscopy among Insured Elderly Population: Comparison of pre- and post-ACA Disparity
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose of the study: Colonoscopy is an evidence-based method for colorectal cancer (CRC)prevention and treatment, but there exist significant disparities in its use among theelderly. The objectives of this paper are to: a) examine income-related factors in CRCscreening in the United States before and after implementation of the Affordable Care Act(ACA), and b) quantify the contributions of different factors in explaining observeddisparities in colonoscopy use by income. Methods Five cycles (2008, 2010, 2012, 2014, and 2016) of Behavioral Risk FactorSurveillance System data for individuals aged 65-75 years were utilized. A ConcentrationIndex (CI), which provides a summary measure of socio-economic disparities, was calculatedbefore and after ACA implementation. Decomposition analysis then examined the relative (%)influence of individual factors (e.g. education, smoking status) associated with incomedisparities in colonoscopy use. Results Income-related CI decreased from +0.1935 to +0.1813 (pre- to post-ACA), indicatinga diminishing influence of income on screening use, though increased use among those withhigher incomes remains. Decomposition analysis showed that relative influence of incomeas a factor increased pre-/post-ACA (from contributing 53.8% of the income disparity to78.6%), while other factors decreased in relative influence (e.g. college education from30.6 to 21.4%) and some were unchanged (e.g. exercise past 30 days from 13.9 to 14.8%; andnon-smoking status from 11.1% to 11.0%). Conclusions We found that the ACA’s removal of financial barriers is associated with theobserved decrease in colonoscopy use disparities across income levels. While other factorsare relatively less important now, income has become as increasingly important singlefactor influencing colonoscopy use across income levels. Interventions aimed at furtherreducing disparities should focus on factors associated with lower income that presentscreening barriers and how they might be addressed. Policy makers should focus on thereduction of further income-related financial barriers, such as lack of paid time off orflexible appointment hours, in the use of colonoscopies among insured elderly.
Keywords: Colonoscopy,Disparity,Concentration Index,Decomposition