EKU Faculty and Staff Scholarship


Disparities in uptake of Colorectal Cancer Screening among Diabetic Patients by Insurance type


Occupational Science and Occupational Therapy

Document Type


Publication Date



Background: Literature suggests that individuals diagnosed with diabetes mellitus (DM) are at greater risk for colorectal cancer (CRC). Differences in uptake by insurance type (public vs. private) are not known. Objectives: To determine the uptake of CRC screening among individuals with DM by insurance type. Methods: This is a cross-sectional analysis of pooled data from the Medical Expenditure Panel Survey (MEPS) 2011-2014. We compared self-reported receipt of CRC screening any type of test within the recommended period (fecal occult blood test within a year, sigmoidoscopy within five years, or colonoscopy within the past 10 years) in age-eligible adult with DM. Multivariate logistic regression models were used to examine the association between up-to-date on CRC screening, health conditions, health service utilization, and annual diabetes care (flu vaccination, feet checkup, eye exam, and hemoglobin A1c test) by type of insurance. Results: Overall prevalence of being up-to-date on CRC screening among individuals with DM was 70.4% in 2011-2014 (74.5% in private vs. 68.9% in public, p<0.0001). Among those with private insurance, up-to-date annual DM care and having routine checkup increased the odds of CRC screening uptake (Odds ratios [ORs]: 1.86 and 1.85, respectively), whereas having history of cancer and diabetes-related comorbidity were associated with up-to-date CRC screening among those with public insurance (ORs: 1.83 and 2.58, respectively). Conclusion: Determinants of CRC screening among individuals with DM differed by insurance type. Our findings suggest that diabetic patients with public insurance may miss screening opportunity unless they have history of cancer or other diabetes-related condition.

Conference Name

American Public Health Association Annual Meeting