Racial and gender variation in use of diagnostic colonic procedures in theMichigan Medicare population

BACKGROUND. There is accumulating evidence that screening programs can alte r the natural history of colorectal cancer, a significant cause of mortalit y and morbidity in the US. Understanding how the technology to diagnose col onic diseases is utilized in the population provides insight into both the access and processes of care. METHOD. Using Medicare Part B billing files from the state of Michigan from 1986 to 1989 we identified all procedures used to diagnose colorectal dise ase. We utilized the Medicare Beneficiary File and the Area Resource File t o identify beneficiary-specific and community-sociodemographic characterist ics. The beneficiary and sociodemographic characteristics were, then, used in multiple regression analyses to identify their association with procedur e utilization. RESULTS. Sigmoidoscopic use declined, dramatically with the increasing age cohorts of Medicare beneficiaries. Urban areas and communities with higher education levels had more sigmoidoscopic use. Among procedures used to exam ine the entire colon, isolated barium enema was used more frequently in Afr ican Americans, the elderly, and females. The combination of barium enema a nd sigmoidoscopy was used more frequently among females and the newest tech nology, colonoscopy, was used most frequently among White males. CONCLUSION, The existence of race, gender, and socioeconomic disparities in the use of colorectal technologies in a group of patients with near-univer sal insurance coverage demonstrates the necessity of understanding the reas on(s) for these observed differences to improve access to appropriate techn ologies to all segments in our society.