"Reducing disparities in colorectal cancer screening among low-income non-elderly adults in the U.S."

Public Health/Health Policy and Management

Committee: 

Lindsay M. Sabik (advisor)
Marian P. Jarlenski 
Scott D. Rothenberger, School of Medicine
Robert E. Schoen, School of Medicine

Abstract:

Colorectal cancer (CRC) is the fourth most common cancer among adults and the second leading cause of cancer deaths in the U.S. Despite the high prevalence and economic burden of CRC, incidence and mortality rates of CRC have been steadily decreasing in the last decade as it is one of few screening-amenable cancers. However, disparities in CRC screening, diagnosis, and survival persist among low-income non-elderly adults as they face a number of socioeconomic barriers to timely access to care, which delays diagnosis and leads to poorer health outcomes. This dissertation assesses temporal trends in CRC screening services utilization among low-income non-elderly adults by region and by insurance type using national survey data for 2010 – 2018; identifies predictors of CRC testing among Medicaid enrollees in Pennsylvania using Medicaid administrative claims data for 2015 – 2019; and, examines multilevel factors related to CRC screening, including expanded insurance coverage under the ACA and improved care delivery with the Colorectal Cancer Control Program (CRCCP), as well as interactions between these two policies using multi-state secondary survey data for 2003 – 2018. The findings of this dissertation will provide insights into the effectiveness of policies and programs developed to reduce disparities in cancer prevention and detection and help inform future initiatives.