RACIAL DISPARITIES AND TRENDS IN USE OF COLORECTAL PROCEDURES AMONG TENNESSEE ELDERLY (1996–2000) Background: Blacks are more likely to be diagnosed at a later stage of colorectal cancer (CRC), and have poorer survival than Whites. Colorectal cancer (CRC) is usually curable when diagnosed at an early stage. Objectives: We compare the use of CRC tests for screening between Whites and Blacks and compare the use of CRC tests for either screening or diagnosis and further check the test results for a diagnosis of CRC. Data: The data we use are from physician claims files provided by the Centers for Medicare and Medicaid Services (CMS) (1996–2000) for a closed cohort of all Ten- nesseans eligible for Medicare in 1996, age $6. Results: Half as many Blacks as Whites were screened with fecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy. Significantly fewer Blacks had any colorectal procedures, sigmoidoscopy, colonoscopy, and/ or barium enema, for screening or diagnosis; however, the test results show that more Blacks were diagnosed with CRC than Whites. The use of CRC tests is low regardless of race. Only 24% of beneficiaries used at least one of the four procedures during the five years. During the five years, FOBT and barium enema use decreased significantly for both Blacks and Whites, while colonoscopy use increased significantly. Sigmoidoscopy use was highest in 1998, which corresponds to the change of Medicare coverage policy in 1998. Conclusions: Removal of financial barriers to screening alone has failed to substantially improve the use of colorectal procedures. Lack of vigilance and lack of access to good quality of care contribute to the fact that Blacks are more likely to be diagnosed at a late stage of CRC than Whites. (Ethn Dis. 2006;16:412– 420) Key Words: Colorectal Cancer, Medicare, Racial Disparities Bojuan B. Zhao, PhD; Barbara Kilbourne, PhD; Steven C. Stain, MD; Van A. Cain, MA; Nathaniel C. Briggs, MD; Baqar A. Husaini, PhD; Robert Levine, MD INTRODUCTION Blacks are more likely to be di- agnosed at a later stage of colorectal cancer (CRC) 1,2 and to have poorer survival than Whites. 2,3 Colorectal can- cer (CRC) survival is closely related to the stage of cancer at diagnosis and is usually curable when diagnosed at an early stage. Studies have been done to try to find the reasons that are related to the late diagnosis, and factors such as patient’s age, sex, race, insurance cover- age, socioeconomic status, residence (urban/rural), and the use of CRC screening tests have been reported. 4–14 Colorectal cancer (CRC) screening tests were not covered for Medicare beneficiaries until 1998. Before January 1, 1998, Medicare covered fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, and double-contrast bari- um enema for diagnosis of CRC for people who have signs or symptoms. Effective January 1, 1998, Medicare added selected coverage for screening. Specifically, for beneficiaries aged 50 and older, Medicare paid for: 1) a screening FOBT every year; 2) a screening sigmoidoscopy every four years; and 3) a screening colonoscopy for high-risk individuals every two years. Medicare also permitted substitution of a double-contrast barium enema for the latter two tests as per physician judg- ment. 15 Effective July 1, 2001, Medi- care started to cover screening colon- oscopy for normal- and low-risk indi- viduals once every 10 years. As a result of the policy change, new Healthcare Common Procedure Coding System (HCPCS) codes have been established for these services. 15 Ko et al 16 investi- gated the effect of the policy change on the use of colorectal tests, and found that the insurance coverage for these tests did not substantially affect the utilization rates for Washington state Medicare beneficiaries in 1994, 1995, and 1998. In this paper, to explore the reasons for more late diagnoses for Blacks than Whites, we not only compared the use of CRC tests for screening between Whites and Blacks, noting the difficulty in distinguishing screening and diagno- sis procedures, but we also compared the use of CRC tests for either screening or diagnosis and further checked the test results for a diagnosis of CRC. Fewer tests but more diagnosed CRC for Blacks is consistent with late-stage di- agnoses for Blacks. The data we used are from physician claims files provided by Centers for Medicare and Medicaid From the Department of Surgery (BBZ, SCS) and the Department of Preventive Medicine (NCB, RL), Meharry Medical College; Center for Health Research at Tennessee State University (BK, VAC, BAH); Nashville, Tennessee. Address correspondence and reprint requests to Bojuan B. Zhao, PhD; Meharry Medical College; Department of Surgery; 1005 DB Todd Blvd; Nashville, TN 37208; 615-327-5692;615-327-5579(fax);bzhao@ mmc.edu Specifically, for beneficiaries aged 50 and older, Medicare paid for: 1) a screening FOBT every year; 2) a screening sigmoidoscopy every four years; and 3) a screening colonoscopy for high-risk individuals every two years. 412 Ethnicity & Disease, Volume 16, Spring 2006