142nd APHA Annual Meeting and Exposition

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Effect of the Affordable Care Act on Colorectal Cancer Screening Utilization

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Susan Nyawade, MSc, B.Ed , Department of Applied Health Science, School of Public Health, Indiana University, Bloomington., Bloomington, IN
Hsien-Chang Lin, PhD, MA , Applied Health Science Department, Indiana University, Bloomington, IN
Hsiao-Yun Lee, MSc
  
BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer deaths affecting both women and men in the United States after lung cancer. CRC risk increases significantly after 50 years. Over 90% cases are diagnosed, yet only 53% are currently up-to-date with screening. Cost is a major barrier to accessing screening. The Affordable Care Act (ACA), implemented in 2010, recommends screening without copay, reducing cost burden for at-risk population.

METHOD: The study was retrospective, multi-year, cross-sectional quasi-experimental design using 2008-2012 Behavior Risk Factor Surveillance System (BRFSS) data. The sample comprised 657,359 adult respondents between 50-75 years from the 50 states and DC. We evaluated effect of ACA on CRC screening uptake using an adapted Reasoned Action Approach model to select variables. We used logistic regression to estimate ACA impact on CRC screening services utilization.

RESULTS: Logistic regression indicated that screening likelihood increased by 22% in 2012 (OR=1.22, 95% Confidence Interval (CI) 1.20-1.11) after ACA implementation. Most predictive factors, positively associated with screening, were having a personal doctor (OR=3.22; 95%CI 3.16-3.29); having health coverage (OR=1.94; 95%CI 1.90-1.98); high income, $50,000 or more (OR=1.40; 95%CI 1.38-1.43); and being a college graduate (OR=2.15; 95%CI 2.10-2.20).

CONCLUSION: We observed an increase in uptake of services after implementation of ACA and strong associations between CRC screening and other behavior-control factors related to cost, a factor that the ACA is expected to alleviate. More attention should focus on enforcing the policy, and using innovative ways to sensitize communities about benefits of ACA and screening and increase enrollment.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe the association between the Affordable Care Act and colorectal cancer screening uptake Identify other factors associated with colorectal cancer screening uptake

Keyword(s): Affordable Care Act, Cancer Prevention and Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conceptualized and conducted the study analyzing data from the Behavior Risk Factor Surveillance System (BRFSS) over a 4 year period. I am currently involved in various research projects in Health Behavior and program and policy evaluation at my school. I worked extensively in the area of Health Education and Promotion.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4275.0: The Affordable Care Act (ACA): Impact, Implementation and Challenges: Poster Session