USPSTF Colorectal Cancer Screening Recommendation and Uptake for Individuals Aged 45 to 49 Years

Abstract

Importance: In May 2021, the US Preventive Services Task Force (USPSTF) issued a grade B recommendation encouraging colorectal cancer (CRC) screening among average-risk individuals aged 45 to 49 years. The patterns of screening uptake and possible socioeconomic disparities in screening in this age group remain unknown.

Objective: To evaluate changes in CRC screening uptake among average-risk individuals aged 45 to 49 years after the USPSTF recommendation was issued in 2021.

Design, setting, and participants: This retrospective cohort study used deidentified claims data from commercially insured Blue Cross Blue Shield beneficiaries aged 45 to 49 years across the US between January 1, 2017, and December 31, 2022.

Exposure: Publication of the May 2021 USPSTF CRC screening recommendation for adults aged 45 to 49 years.

Main outcomes and measures: Absolute and relative changes in screening uptake were compared between a 20-month period preceding (May 1, 2018, to December 31, 2019) and a 20-month period following (May 1, 2021, to December, 31, 2022) the USPSTF recommendation. Interrupted time-series analysis and autoregressive integrated moving average models were used to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality.

Results: In this cohort study of 10 221 114 distinct beneficiaries aged 45 to 49 years (mean [SD] age, 47.04 [1.41] years; 51.04% female), bimonthly mean (SD) numbers of average-risk beneficiaries were 3 213 935 (31 508) and 2 923 327 (105 716) in the prerecommendation and postrecommendation periods, respectively. Mean (SD) screening uptake increased from 0.50% (0.02%) to 1.51% (0.59%) between the 2 periods (P < .001), representing an absolute change of 1.01 percentage points (95% CI, 0.62-1.40 percentage points) but no significant relative change (202.51%; 95% CI, -30.59% to 436.87%). Compared with average-risk beneficiaries residing in areas with the lowest socioeconomic status (SES), those residing in areas with the highest SES experienced the largest absolute change in screening (1.25 [95% CI, 0.77-1.74] percentage points vs 0.75 [95% CI, 0.47-1.02] percentage points), but relative changes were not significant (214.01% [95% CI, -30.91% to 461.15%] vs 167.73% [95% CI, -16.30% to 352.62%]). After the recommendation was issued, the screening uptake rate also increased fastest among average-risk beneficiaries residing in the areas with highest SES (0.24 [95% CI, 0.23-0.25] percentage points every 2 months) and metropolitan areas (0.20 [95% CI, 0.19-0.21] percentage points every 2 months).

Conclusions and relevance: This study found that among privately insured beneficiaries aged 45 to 49 years, CRC screening uptake increased after the USPSTF recommendation, with potential disparities based on SES and locality.

Figure 1.. Bimonthly Colorectal Cancer (CRC) Screening Uptake Among Blue Cross Blue Shield (BCBS) Beneficiaries Aged 45 to 75 Years

^aScreening uptake was calculated by dividing the number of BCBS beneficiaries in the age group who received CRC screening by the number who (1) had BCBS as the primary insurance for at least 12 months prior to the start of the period and remained enrolled through the end of the 2-month period and (2) did not receive CRC screening or related procedures in the 12 months preceding the 2-month period. Individuals screened multiple times were included to assess the overall utilization of each screening modality.

Figure 2.. Absolute Change in Uptake of Screening for Colorectal Cancer Among Blue Cross Blue Shield Beneficiaries Aged 45 to 49 Years Comparing Prerecommendation and Postrecommendation Periods

The prerecommendation period was from May 1, 2018, to December 31, 2019, and the postrecommendation period was from May 1, 2021, to December 31, 2022. pp Indicates percentage points. ^aQuintile 1 represents the highest socioeconomic status. ^bRace and ethnicity information was available for 35.2% and 32.1% of beneficiaries during the prerecommendation and postrecommendation periods, respectively.

Figure 3.. Relative Change in Uptake of Screening for Colorectal Cancer Among Blue Cross Blue Shield Beneficiaries Aged 45 to 49 Years Comparing Prerecommendation and Postrecommendation Periods

The prerecommendation period was from May 1, 2018, to December 31, 2019, and the postrecommendation period was from May 1, 2021, to December 31, 2022. ^aQuintile 1 represents the highest socioeconomic status. ^bRace and ethnicity information was available for 35.2% and 32.1% of beneficiaries during the prerecommendation and postrecommendation periods, respectively.

Figure 4.. Results From Stratified Autoregressive Integrated Moving Average Models Assessing 2-Month Change in Rate of Postrecommendation Colorectal Cancer Screening Uptake

Data are from May 1, 2021, to December 31, 2022, for Blue Cross Blue Shield beneficiaries aged 45 to 49 years. pp Indicates percentage points. ^aQuintile 1 represents the highest socioeconomic status. ^bRace and ethnicity information was available for 35.2% and 32.1% of beneficiaries during the prerecommendation and postrecommendation periods, respectively.