Colorectal cancer screening: Virginia health districts in greatest need and the impact of insurance coverage on fecal occult blood testing and endoscopy

Background: Colorectal cancer (CRC) is the second most common cancer in the United States. CRC deaths can be prevented with screening; however, the uninsured are often less likely to have recommended screening.   Moreover, it is not clear where the greatest areas of CRC screening need are within Virginia. 

Objectives: This study aims to compare the prevalence of CRC screening among Virginia adults ages 50 and older by insurance status and health district. Also, this study aims to assist the Every Women’s Life (EWL) program by determining health districts in greatest need of CRC screening. 
 
Methods: Cross-sectional data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. Descriptive statistics were generated. Weighted multiple regression was used to assess the association between insurance coverage and CRC screening prevalence among Virginia adults ages 50 and older (N=3,030) as well as CRC screening prevalence by health district. Also, arcGIS was used to map screening prevalence by health district. 

Results: After adjustment, men with insurance were more likely to have ever had fecal occult blood test (FOBT) or endoscopy (p<.01) compared to those without insurance and they were more likely to have either modality according to recommended guidelines (p=.0004). Women with insurance were not statistically more likely to have CRC screening than those without insurance. CRC screening per recommendations for men was lowest in the Central Virginia Health District (19.39%) whereas overall adherence for women was lowest in the Cumberland Plateau Health District (38.65%). 

Conclusion: Insurance coverage seems to impact whether men receive CRC screening, but, has no association with screening for Virginia women. Health districts in greatest need of CRC screening differ by gender. Overall, EWL screening efforts should be targeted to specific health districts in southwestern and central Virginia as well as along the eastern shore.