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. 2021 Nov;30(11):2667-2685.
doi: 10.1002/hec.4397. Epub 2021 Aug 2.

Effects of the Colorectal Cancer Control Program

Marianne P Bitler  1 , Christopher S Carpenter  2 , Danea Horn  3
Affiliations

Effects of the Colorectal Cancer Control Program

Marianne P Bitler et al. Health Econ. 2021 Nov.

Abstract

Although colorectal cancer (CRC) screening is highly effective, screening rates lag far below recommended levels, particularly for low-income people. The Colorectal Cancer Control Program (CRCCP) funded $100 million in competitively awarded grants to 25 states from 2009-2015 to increase CRC screening rates among low-income, uninsured populations, in part by directly providing and paying for screening services. Using data from the 2001-2015 Behavioral Risk Factor Surveillance System (BRFSS) and a difference-in-differences strategy, we find no effects of CRCCP on the use of relatively cheap fecal occult blood tests (FOBT). We do, however, find that the CRCCP significantly increased the likelihood that uninsured 50-64-year-olds report ever having a relatively expensive endoscopic CRC screening (sigmoidoscopy or colonoscopy) by 2.9 percentage points, or 10.7%. These effects are larger for women, minorities, and individuals who did not undertake other types of preventive care. We do not find that the CRCCP led to significant changes in CRC cancer detection. Our results indicate that the CRCCP was effective at increasing CRC screening rates among the most vulnerable.

Keywords: CRCCP; colorectal cancer screenings.

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Conflict of interest statement

We have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. States Receiving CRCCP Grants in FY 2009/2010
Notes: Figure presents states receiving CRCCP grants starting in FY 2009 (7/2008–6/2009) or FY 2010 (7/2009–6/2010).
Figure 2
Figure 2. Trends in the Probability an Individual Ever had a Fecal Occult Blood Stool Test, by Insurance Status and Whether State Participated in CRCCP
50–64-year-old men and women, 2002–2014 BRFSS (even years only) Notes: The figure shows means for ever having had FOBT in even years by whether or not the state adopted CRCCP in 2009/2010 and by insurance status, using BRFSS data for 2002–2014 for 50–64 year olds. The orange line with cross hatches represents means for the uninsured 50–64-year olds in states who adopted CRCCP in 2009 or 2010, the yellow line with square markers represents means for the uninsured in states which never adopt CRCCP during 2002–2014. The light blue line with square markers represents means for those 50–64-year olds with insurance who adopted CRCCP in 2009/2010 and the darker blue line with diamond markers represents means for the insured in states which never adopt CRCCP during 2002–2014. Means are weighted to be population representative.
Figure 3
Figure 3. Trends in the Probabily an Individual Ever had a Sigmoidoscopy or Colonoscopy, by Insurance Status and Whether State Participated in CRCCP
50–64-year-old men and women, 2002–2014 BRFSS (even years only) Notes: The figure shows means for ever having had a sigmoidoscopy or colonoscopy in even years by whether or not the state adopted CRCCP in 2009/2010 and by insurance status, using BRFSS data for 2002–2014 for 50–64 year olds. The orange line with cross hatches represents means for the uninsured 50–64-year olds in states who adopted CRCCP in 2009 or 2010, the yellow line with square markers represents means for the uninsured in states which never adopt CRCCP during 2002–2014. The light blue line with square markers represents means for those 50–64-year olds with insurance who adopted CRCCP in 2009/2010 and the darker blue line with diamond markers represents means for the insured in states which never adopt CRCCP during 2002–2014. Means are weighted to be population representative.
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References

    1. American Cancer Society (2017). “Colorectal Cancer Fact & Figures 2017–2019,” Atlanta: American Cancer Society.
    1. Bertrand Marianne, Duflo Esther, and Mullainathan Sendhil (2004). “How Much Should We Trust Difference-In-Differences Estimates?” Quarterly Journal of Economics, 119(1): 249–275.
    1. Bibbins-Domingo Kirsten, Grossman David C., Curry Susan J., Davidson Karina W., Epling John W. Jr., Garcia Francisco A. R., Gillman Matthew W., Harper Diane M., Kemper Alex R., Krist Alex H., Kurth Ann E., Landefeld C. Seth, Mangione Carol M., Owens Douglas K., Phillips William R., Phipps Maureen G., Pignone Michael P., and Siu Albert L. (2016). “Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement,” JAMA, 315(23): 2564–2575. - PubMed
    1. Bitler Marianne P. and Carpenter Christopher S. (2019). “Effects of Direct Care Provision to the Uninsured: Evidence from Federal Breast and Cervical Cancer Programs,” NBER Working Paper #26140.
    1. Burnett-Hartman Andrea N., Mehta Shivan J., Zheng Yinge, Ghai Nirupa R., McLerran Dale, Chubak Jessica, Quinn Virginia P., Skinner Celette Sugg, Corley Douglas A., Inadomi John, and Doubeni Chyke A., on behalf of the PROSP Consortium (2016). “Racial/Ethnic Disparities in Colorectal Cancer Screening Across Healthcare Systems,” American Journal of Preventive Medicine, 51(4): e107–e115. - PMC - PubMed

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