Summary
Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening.
Original Article
The Impact of Medicare Health Insurance Coverage on Lung Cancer Screening
Medical Care
Sun, Jiren BS; Perraillon, Marcelo Coca PhD; Myerson, Rebecca PhD
Abstract
Background:
Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening.
Objective:
The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening.
Research Design:
A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk.
Subjects:
A total of 11,163 individuals at high risk for lung cancer just above and below age 65.
Measure:
Self-reported use of low-dose computed tomography to screen for lung cancer in the past 12 months.
Results:
A total of 10,951 people at high lung cancer risk (45.7% women, response rate=98.1%) reported lung cancer screening information. Nearly universal access to Medicare increased lung cancer screening by 16.2 percentage points among men (95% confidence interval: 2.4%–30.0%, P=0.02), compared with a baseline screening rate of 11.1% just younger than age 65. Women had a baseline screening rate of 18.2% and experienced no statistically significant change in screening (1.6 percentage point increase, 95% confidence interval: −19.8% to 23.0%, P=0.88).
Conclusions:
Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening.
Acknowledgments
R.M. acknowledges support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health, the Office of The Director, National Institutes of Health (OD), and the National Cancer Institute (NCI) under Award Number K12HD101368, and support from the University of Wisconsin Carbone Cancer Center Support Grant (NCI P30 CA014520). M.C.P. acknowledges support from the Population Health Share Resources and funding from the University of Colorado Cancer Center Core Support Grant (NCI P30CA046934). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.