Screening colonoscopy rates dropped significantly among insured Americans during the recession of December 2007 to June 2009, compared with prerecession rates, according to a report published in the March issue of Clinical Gastroenterology and Hepatology.
"These findings reflect the intimate link between socioeconomic factors and health care use," wrote Dr. Spencer D. Dorn of the University of North Carolina at Chapel Hill and his colleagues.
Dr. Spencer Dorn
"When faced with economic insecurity, asymptomatic individuals may be unable to afford screening colonoscopy, or may perceive it to be less important than competing demands for their more limited resources," they noted.
"Down the line, this may increase health care costs and the proportion of individuals diagnosed with late-stage colorectal cancer," the authors added (Clin. Gastroenterol. Hepatol. 2012 March [doi: 10.1016/j.cgh.2011.11.020]).
Dr. Dorn and his colleagues analyzed data from a random sample of all persons aged 50-64 years across 106 commercial health plans in the United States with at least 6 months of continuous health plan enrollment.
The investigators then compared trends in the monthly rate of screening colonoscopies (per 1 million eligible beneficiaries) prior to the recession (January 2005 to November 2007) with rates during the recession (December 2007 to June 2009).
The time periods were defined by the National Bureau of Economic Research.
"We hypothesized a priori that there would not be an abrupt decline in screenings given the recession’s gradual onset and therefore chose to only model changes in the trend of screenings before and during the recession," they wrote.
Indeed, Dr. Dorn and his coauthors found that prior to the recession, screening colonoscopies increased at a rate of 38.2 more colonoscopies per 1 million insured individuals per month (95% confidence interval, 32.4-43.9).
However, during the recession, screening colonoscopy use declined, to the tune of 30.7 fewer colonoscopies per 1 million insured individuals per month (95% CI, –42.2 to –19.1).
"In sum, compared to what would have been expected based on prerecession trends, during the recession, screening colonoscopy use declined at a rate of 68.9 (95% CI, –84.6 to –53.1) fewer colonoscopies per 1 million insured individuals per month (P less than .001)," the authors wrote.
They also looked at utilization rates stratified according to low versus high out-of-pocket cost plans.
They found that during the recession, among low-cost plans ($50 or less per month), screening colonoscopies declined at a rate of 58.1 fewer colonoscopies than expected per 1 million insured patients.
However, among high-cost plans ($300 or more per month), the decline was even more pronounced, with 81.5 fewer colonoscopies than expected per 1 million insured patients (P = .035).
"Applying the decreased utilization documented here to the 39.5 million commercially insured, 50- to 64-year-old Americans, over the entire 19-month recession period, this would have resulted in 516,309 fewer colonoscopies than what would have been expected based on prerecession trends," they added.
"Policies to reduce patient cost sharing for colonoscopy and other recommended, cost-effective preventive services should be considered," Dr. Dorn and his colleagues concluded.
The study was supported in part by grants from the National Institutes of Health and the Crohn’s and Colitis Foundation of America. The authors stated that they had no relevant financial disclosures.