Table 3.
Results from the Multilevel, Multivariable Model Predicting the Use of Colorectal Cancer Screening Services by Dually and Nondually Eligible Medicare–Medicaid Beneficiaries
| Fecal Occult Blood Test (FOBT) (N=2,590,582) | Flexible Sigmoidoscopy (FLEX) (N=391,329) | Colonoscopy with either FLEX or COL (COL_WFF) (N=177,147) | Colonoscopy Only (COL_ONLY) (N=558,755) | |
|---|---|---|---|---|
| County characteristics | ||||
| Managed care activity level | ||||
| Low (ref) | – | – | – | – |
| Moderate | 1.03 (0.89, 1.19) | 1.02 (0.90, 1.16) | 1.08 (0.96, 1.23) | 1.10 (1.00, 1.22) |
| High | 1.29 (1.06, 1.57)a | 1.49 (1.24, 1.78)c | 1.11 (0.95, 1.30) | 0.91 (0.79, 1.04) |
| Physician resources | ||||
| Number of gastroenterologists* | 1.15 (0.98, 1.35) | 1.13 (0.94, 1.35) | 1.06 (0.92, 1.21) | 1.09 (0.96, 1.24) |
| Number of primary care providers† | 0.85 (0.75, 0.97)a | 0.96 (0.85, 1.10) | 0.96 (0.86, 1.06) | 0.97 (0.87, 1.09) |
| Proportion of primary care providers to all physicians | 0.52 (0.40, 0.69)c | 0.81 (0.58, 1.12) | 0.57 (0.44, 0.73)c | 0.83 (0.63, 1.09) |
| Other county attributes | ||||
| Proportion of individuals ≥65 years' age below the federal poverty level* | 0.97 (0.91, 1.04) | 1.01 (0.95, 1.08) | 0.98 (0.93, 1.02) | 1.02 (0.98, 1.07) |
| Proportion of individuals with high school diploma* | 1.06 (1.00, 1.12)a | 1.14 (1.08, 1.20)c | 1.03 (0.99, 1.07) | 1.02 (0.98, 1.06) |
| Proportion of elderly residing in nursing homes | 1.02 (0.14, 7.28) | 0.12 (0.02, 0.72)a | 0.28 (0.06, 1.40) | 1.57 (0.36, 6.75) |
| Characteristics of Medicare beneficiaries | ||||
| Dual enrollment in Medicare–Medicaid | 0.48 (0.45, 0.51)c | 0.55 (0.49, 0.61)c | 0.60 (0.54, 0.67)c | 0.85 (0.80, 0.89)c |
| Gender | ||||
| Female (Ref) | – | – | – | – |
| Male | 0.72 (0.68, 0.76)c | 1.17 (1.12, 1.22)c | 1.09 (1.04, 1.14)c | 1.19 (1.15, 1.23)c |
| Race | ||||
| Caucasian (Ref) | – | – | – | – |
| African American | 0.63 (0.57, 0.70)c | 0.70 (0.63, 0.79)c | 0.72 (0.65, 0.78)c | 0.76 (0.70, 0.82)c |
| Other race/ethnicity | 0.97 (0.78, 1.20) | 0.85 (0.74, 0.97)a | 1.03 (0.78, 1.36) | 0.92 (0.79, 1.07) |
| Age groups (years) | ||||
| 65–69 (ref) | – | – | – | – |
| 70–74 | 0.98 (0.96, 1.00) | 0.93 (0.90, 0.95)c | 1.01 (0.97, 1.06) | 1.05 (1.02, 1.08)c |
| 75–79 | 0.88 (0.85, 0.91)c | 0.75 (0.73, 0.78)c | 0.88 (0.84, 0.93)c | 1.01 (0.99, 1.04) |
| 80–84 | 0.68 (0.65, 0.71)c | 0.53 (0.50, 0.56)c | 0.65 (0.61, 0.70)c | 0.85 (0.81, 0.89)c |
| 85+ | 0.39 (0.37, 0.42)c | 0.26 (0.23, 0.29)c | 0.35 (0.30, 0.40)c | 0.52 (0.49, 0.55)c |
| Cross-level interactions | ||||
| Dual × managed care Activity: | – | – | – | – |
| Low (ref) moderate | 1.01 (0.84, 1.22) | 0.88 (0.74, 1.06) | 0.97 (0.79, 1.18) | 0.91 (078, 1.05) |
| High | 0.82 (0.70, 0.96)a | 0.61 (0.51, 0.73)c | 0.69 (0.52, 0.93)a | 0.77 (0.69, 0.85)c |
a
0.01<p≤.05
b
0.001<p≤.01
c
p≤.001.
All other statistics not significant at p >0.05.
*
Odds ratios to be interpreted relative to a 5-point increase.
†
Odds ratios to be interpreted relative to a 50-point increase.