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- Title
Assessing the impact of screening colonoscopy on mortality in the medicare population.
- Authors
Gross, Cary; Soulos, Pamela; Ross, Joseph; Cramer, Laura; Guerrero, Christopher; Tinetti, Mary; Braithwaite, R.; Gross, Cary P; Soulos, Pamela R; Ross, Joseph S; Cramer, Laura D; Tinetti, Mary E; Braithwaite, R Scott
- Abstract
<bold>Background: </bold>Some have recommended against routine screening for colorectal cancer (CRC) among patients ≥75 years of age, while others have suggested that screening colonoscopy (SC) is less beneficial for women than men. We estimated the expected benefits (decreased mortality from CRC) and harms (SC-related mortality) of SC based on sex, age, and comorbidity.<bold>Objective: </bold>To stratify older patients according to expected benefits and harms of SC based on sex, age, and comorbidity.<bold>Design: </bold>Retrospective study using Medicare claims data.<bold>Participants: </bold>Medicare beneficiaries 67-94 years old with and without CRC.<bold>Main Measures: </bold>Life expectancy, CRC- and colonoscopy-attributable mortality rates across strata of sex, age, and comorbidity, pay-off time (i.e. the minimum time until benefits from SC exceeded harms), and life-years saved for every 100,000 SC.<bold>Key Results: </bold>Increasing age and comorbidity were associated with lower CRC-attributable mortality. Due to shorter life expectancy and CRC-attributable mortality, the benefits associated with SC were substantially lower among patients with greater comorbidity. Among men aged 75-79 years with no comorbidity, the number of life-years saved was 459 per 100,000 SC, while men aged 67-69 with ≥3 comorbidities had 81 life-years saved per 100,000 SC. There was no evidence that SC was less effective in women. Among men and women 75-79 with no comorbidity, number of life-years saved was 459 and 509 per 100,000 SC, respectively; among patients with ≥3 comorbidities, there was no benefit for either men or women.<bold>Conclusions: </bold>Although the effectiveness of SC was equivalent for men and women, there was substantial variation in SC effectiveness within age groups, arguing against screening recommendations based solely on age.
- Subjects
UNITED States; COLONOSCOPY; MEDICAL screening; MEDICARE; COLON cancer; MEDICARE beneficiaries; LIFE expectancy; COLON tumors; PUBLIC health surveillance; RECTUM tumors; RESEARCH funding; RETROSPECTIVE studies; DIAGNOSIS
- Publication
JGIM: Journal of General Internal Medicine, 2011, Vol 26, Issue 12, p1441
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-011-1816-4