Julie S Townsend MS Epidemiologist Division of Cancer Prevention and Control NAACCRIARC Conference June 13 2019 CRC in Kentucky Collaborative and strategic efforts to expand CRC screening across the state ID: 777468
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Slide1
Early- and late-age onset colorectal cancer in Kentucky: using health administrative claims-linked cancer registry data to better understand risk factors and comorbidities
Julie S. Townsend, MS
Epidemiologist, Division of Cancer Prevention and Control
NAACCR/IARC Conference
June 13, 2019
Slide2CRC in Kentucky
Collaborative and strategic efforts to expand CRC screening across the state
Incidence rates peaked in 2001 at 64.0 per 100,000
Lowest incidence rates in 2015 at 48.4 per 100,000
Considerable progress in reducing overall CRC incidence rates
Slide3Background
Early-onset Colorectal Cancer (CRC): diagnosed before age 50 years
In the United States,
incidence and
death
rates for colorectal cancer (CRC) have been increasing in persons aged <50
years
Relatively rare among persons aged < 50 years: 7.6 cases per 100,000 in the US from 2011 – 2015
Highest incidence rates
over past 5 years
in Kentucky (9.6 per 100,000) among persons < 50 years
Slide4CRC Risk Factors
Slide5Purpose
Study Question
To better understand these trends, we sought to examine risk factors, comorbidities, and screening test use among Kentucky CRC patients
Slide6Methods
Years: 2007 – 2011Registry data probabilistically linked to claims data from a set of public
(including Medicare and Medicaid),
state employee database, and private Kentucky insurers
Inclusion criteria:
First primary CRC cases
Continuously enrolled for one year prior to their cancer diagnosis
Had at least 1 claim
ICD 9 and CPT codes from claims data captured chronic conditions, screening test use, and risk factors
Captured within
1 year prior
diagnosisDescriptive analysis in SAS comparing early-onset to late-onset CRC patients
Demographic and tumor characteristics
Comorbidities, CRC risk factors, family history of CRC
Screening test use
Average time from screening to diagnosis confirmation, to initial treatment
Data linkages between Kentucky Cancer Registry and health administrative claims data
Slide7Results
Kentucky, 2007 - 2011
Slide8Early-onset CRC patients were more frequently male, had rectal cancer, and no other comorbidities
Slide9However, these differences among early- and late-onset patients were not drastically different
Regional and distant
stage tumors were more
common among early-onset CRC patients
Slide10There was considerable variation in mean time to diagnosis in both age groups
Mean time to diagnosis and treatment did not differ among early- and late-onset CRC patients in Kentucky
Early-onset
Late-onset
Mean time from diagnostic colonoscopy to CRC diagnosis
18.95±58.79
22.62±61.40
Mean time from CRC diagnosis to treatment initiation
13.04±18.85
14.43±23.41
Slide11Late-onset CRC patients had higher prevalence of diabetes, hypertension, and poor lipid profiles
Family history of CRC, IBD, obesity, and use of smoking cessation medications were more common among early-onset CRC patients
Slide12Early-onset CRC patients more frequently had colonoscopy
Slide13LimitationsObesity prevalence based on claims data
was severely underestimatedExamined risk factors in the year prior to diagnosis, so long term history was not collectedMay affect obesity prevalence, because weight loss associated with advanced CRC
Difficult to discern screening colonoscopy vs. diagnostic colonoscopy Excluded the uninsured
The primary purpose of claims data is for billing, so it can’t always address every research question
Slide14Summary
Claims data useful to identify comorbidities and screening test useThe linkage included Medicaid and privately insured
patientsIn Kentucky, early-onset CRC patients more frequently had obesity, family history of CRC, and IBD than older counterpartsDiabetes and tobacco-use history both relatively common in early- and late-onset CRC patients
These findings indicate that many early-onset CRC patients may be at risk for a second cancer given their history of obesity, diabetes, and tobacco useImproved recognition of these risk factors in people under age 50 may allow for healthcare discussions about starting screening earlier, if appropriate
Supplementing cancer registry data with claims data has many benefits
Slide15Acknowledgements:
Kentucky Cancer RegistryBin Huang,
DrPHQuan Chen, DrPH
Eric Tai, MD, MS
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