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Impact of Age and Comorbidity on Colorectal Cancer Screening Among Older Veterans
- Louise C. Walter, MD;
- Karla Lindquist, MS;
- Sean Nugent, BA;
- Tammy Schult, MS;
- Sei J. Lee, MD, MAS;
- Michele A. Casadei, BS; and
- Melissa R. Partin, PhD
- From the San Francisco Veterans Affairs Medical Center and the University of California, San Francisco, California, and the Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.
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Figure 1. Study flow diagram.Eligibility criteria included having been seen in an outpatient clinic at 1 of 4 Veterans Affairs (VA) centers between 1 January 2001 and 31 December 2002, which indicated that the VA was at least partially responsible for medical care, but data on colorectal cancer screening were gathered during the entire 2-year screening interval from both national VA and Medicare claims. Additional eligibility criteria included having at least 1 outpatient visit between 1 January and 31 December 2000 to define comorbidity as of 1 January 2001.
* Defined by searching VA and Medicare inpatient and outpatient claims before 1 January 2001, dating as far back as 1 October 1992 for VA claims and 1 January 1999 for Medicare claims.
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Figure 2. Colorectal cancer screening incidence versus 5-year mortality for different age groups as comorbidity increases (n = 27 068).Within each age group, screening incidence decreased only a small amount as comorbidity worsened. The lines illustrate the relatively flat incidence of screening among patients with no comorbidity, average comorbidity, and severe comorbidity for each age group. If screening was targeted to older patients with substantial life expectancies and away from those with severe comorbidity, all lines would start much higher and slope down more steeply.
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Figure 3. Patients 70 years or older who had colorectal cancer screening in 2001 or 2002, by comorbidity and number of Veterans Affairs outpatient visits (n = 27 068).Number of visits was defined by the number of visits between 1 January 2001 and 31 December 2002 to Veterans Affairs primary care, gastroenterology, or general surgery clinics (clinic codes 301, 303, 305, 306, 307, 309, 312, 321 to 323, and 401).
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