Article Figures & Data
Figures
- Figure 1.
Study care phases.
- Figure 2.
Adjusted relative risk of influenza vaccination, mammography, and diabetes care measures (hemoglobin A1c and lipid testing) by cancer/control status and phase. Adjusted for the following variables: age, sex (when applicable), race ethnicity, median annual household income in ZIP code percent of those ≥25 years old who graduated from high school in zip code, reason for Medicare, National Cancer Institue combined comorbidity index, and number of hospitalizations. Note that relative risk scales differ for each measure.
Tables
Total CRC Cases Controls Stage 0–1 Stage 2–3 Year before prediagnosis phase (year −2) 103,830 8,865 13,296 81,669 Phase before diagnosis (year −1) 103,830 8,865 13,296 81,669 Phase after initial treatment (year 1) 103,830 8,865 13,296 81,669 Surveillance phase Year 2 88,859 7,548 10,679 70,632 Year 3 67,959 5,573 7,672 54,714 Year 4 50,159 4,082 5,366 40,711 Survival phase Year 5 35,134 2,825 3,575 28,734 Year 6 22,635 1,791 2,240 18,604 Year 7 12,262 991 1,140 10,131 CRC, colorectal cancer.
CRC Cases Controls (n = 81,669) Stage 0–1 (n = 8,865) Stage 2–3 (n = 13,296) Age, years* 67–69 15.6 13.8 19.5 70–74 29.4 27.5 32.3 75–79 28.0 27.5 25.1 80–89 27.1 31.2 23.1 Female* 53.9 56.6 62.8 Race/ethnicity* White 86.6 87.2 84.8 Asian 3.5 3.3 3.8 Black 6.3 6.1 6.6 Hispanic 1.0 1.1 2.2 Other 2.6 2.3 2.7 National Cancer Institute combined comorbidity index during the phase before diagnosis year* ≤0 71.7 74.7 76.1 >0–0.5 14.6 13.5 12.4 >0.5–1.0 8.1 7.5 7.4 >1.0 5.6 4.4 4.1 Hospitalizations during the phase before diagnosis year† 0 85.3 86.9 86.6 1 11.1 10.1 10.1 2 2.6 2.1 2.4 3 0.8 0.6 0.6 4 0.2 0.3 0.2 ≥5 0.1 0.1 0.1 Annual visits to cancer care physicians (mean [SD])‡ Phase after initial treatment* 1.4 (3.2) 4.6 (7.1) 0.3 (1.4) Surveillance phase* 0.7 (1.7) 1.3 (2.1) 0.3 (1.4) Survival phase* 0.5 (1.5) 0.8 (1.6) 0.4 (1.5) Visits to noncancer care physicians during the phase before diagnosis year* ≤7 42.6 50.0 50.1 8–15 33.0 30.2 29.2 16–25 16.6 14.2 14.2 >25 7.8 5.6 6.5 Reason for Medicare eligibility§ Age ≥65 years 94.1 94.7 93.9 Disability/end-stage renal disease 5.9 5.3 6.1 Percent of those ≥25 years old who graduated from high school in ZIP code*‖ 0–50 1.7 1.7 2.1 50–75 16.0 16.2 17.6 75–90 54.8 54.5 52.2 >90 27.6 27.7 28.1 Median annual household income in ZIP code*‖ ≤$30,000 8.2 8.6 10.3 >$30,000–45,000 38.4 39.0 38.2 >$45,000 53.4 52.4 51.5 Values provided as % unless otherwise specified.
* P ≤ .001.
† P ≤ .05.
‡ Cancer care physicians include general surgeons, colorectal surgeons, medical oncologists, radiation oncologists.
§ P ≤ .01.
‖ Missing values: people ≥25 years old who graduated from high school in ZIP code (%): stage 0–1, n = 207 (2.3%); stage 2–3, n = 300 (2.3%); controls, n = 2274 (2.8%); median annual household income in ZIP code: stage 0–1, n = 210 (2.4%); stage 2–3, n = 301 (2.3%); controls, n = 2286 (2.8%).
CRC.
- Table 3.
Unadjusted Annual Rates of Influenza Vaccination, Mammography, and Diabetes Care Measures by Cancer/Control Status and Year/Phase
Observation Year Phase before Diagnosis Phase after Initial Treatment Surveillance Phase Survival Phase −1 1 2 3 4 5 6 7 Influenza vaccination* Stage 0–1 CRC cases† 50.9 (49.6–52.1) 53.2 (52.0–54.4) 53.9 (52.5–55.3) 51.9 (50.2–53.6) 52.6 (49.5–53.7) 52.4 (49.5–55.3) 52.5 (47.0–58.0) Stage 2–3 CRC cases‡ 46.4 (45.4–47.4) 50.2 (49.1–51.2) 49.9 (48.7–51.1) 49.3 (47.8–50.8) 47.5 (45.5–49.4) 49.2 (46.5–51.9) 51.1 (46.2–56.0) Controls§ 46.1 (45.7–46.5) 47.0 (46.6–47.4) 47.6 (47.1–48.0) 48.0 (47.4–48.5) 48.1 (47.4–48.7) 45.9 (45.0–46.8) 48.3 (46.7–49.9) Mammography‖ Stage 0–1 CRC cases¶ 41.6 (39.1–44.1) 45.0 (42.5–47.5) 43.6 (40.7–46.6) 48.0 (44.3–51.8) 49.6 (44.7–54.5) 52.4 (44.7–58.2) 52.4 (41.7–63.1) 50.0 (25.5–74.5) Stage 2–3 CRC cases** 31.4 (29.4–33.4) 40.2 (38.1–42.3) 44.3 (41.5–47.0) 46.2 (42.7–49.7) 46.6 (41.8–51.4) 52.5 (45.6–59.5) 52.9 (42.3–63.6) 62.5 (38.8–86.2) Controls†† 38.6 (37.9–39.2) 40.5 (39.8–41.2) 41.1 (40.3–41.9) 42.5 (41.5–43.4) 42.5 (41.3–43.8) 44.2 (42.6–45.9) 44.4 (41.8–47.0) 43.2 (37.3–49.1) HgbA1c testing (among diabetics)‡‡ Stage 0–1 CRC cases§§ 55.9 (53.0–58.7) 60.1 (57.3–62.9) 64.1 (60.9–67.2) 64.3 (60.2–67.9) 66.8 (62.2–71.3) 70.1 (64.6–75.7) 73.6 (66.7–80.4) 67.9 (57.7–78.1) Stage 2–3 CRC cases‖∥ 53.4 (51.0–55.8) 54.9 (52.5–57.3) 59.4 (56.5–62.2) 60.4 (56.9–63.8) 64.4 (60.1–68.6) 62.7 (57.2–68.1) 62.5 (55.2–69.8) 72.1 (61.4–82.7) Controls¶¶ 53.7 (52.6–54.7) 58.7 (57.7–59.7) 61.2 (60.0–62.2) 62.9 (61.6–64.2) 64.6 (63.1–66.1) 66.1 (64.2–67.9) 66.5 (64.2–68.9) 67.8 (64.6–71.1) Serum lipid measurements (among diabetics)*** Stage 0–1 CRC cases††† 57.3 (54.4–60.2) 52.8 (50.0–55.7) 57.6 (54.3–60.8) 53.6 (49.6–57.6) 57.1 (52.4–61.9) 60.5 (54.6–66.5) 59.8 (52.1–67.4) 59.3 (48.6–70.0) Stage 2–3 CRC cases‡‡‡ 51.0 (48.6–53.4) 47.9 (45.5–50.3) 48.6 (45.7–51.5) 50.6 (47.1–54.1) 52.1 (47.7–56.6) 54.7 (49.0–60.3) 51.8 (44.2–59.3) 48.5 (46.7–60.4) Controls§§§ 52.6 (51.6–53.7) 53.2 (52.1–54.2) 54.4 (53.2–55.5) 55.5 (54.2–56.8) 57.9 (56.3–59.4) 57.5 (55.6–59.4) 58.5 (56.0–61.0) 61.3 (57.9–64.7) Values provided as % (CI).
* Difference in trend in receipt of influenza vaccination between stage 0–1 CRC cases and controls is nonsignificant, between stage 2–3 CRC cases and controls, P≤ .001; between stage 0–1 and stage 2–3, P ≤ .05.
† Test for trend in receipt of influenza vaccination over time for stage 0–1 CRC cases is nonsignificant.
‡ Test for trend in receipt of influenza vaccination over time for stage 2–3 CRC cases, P ≤ .001.
§ Test for trend in receipt of influenza vaccination over time for controls, P ≤ .01.
‖ Difference in trend in receipt of mammography between stage 0–1 CRC cases and controls is nonsignificant; between stage 2–3 CRC cases and controls, P ≤ .001; between stage 0–1 and stage 2–3, P ≤ .05.
¶ Test for trend in receipt of mammography over time for stage 0–1 CRC cases, P ≤ .001.
** Test for trend in receipt of mammography over time for stage 2–3 CRC cases, P ≤ .001.
†† Test for trend in receipt of mammography over time for controls, P ≤ .001.
‡‡ Difference in trend in HgbA1c testing between stage 0–1 CRC cases and controls is nonsignificant; between stage 2–3 CRC cases and controls is nonsignificant; and between stage 0–1 and stage 2–3 is nonsignificant.
§§ Test for trend in HgbA1c testing over time for stage 0–1 CRC cases, P ≤ .001.
‖∥ Test for trend in HgbA1c testing over time for stage 2–3 CRC cases, P ≤ .001.
¶¶ Test for trend in HgbA1c testing over time for controls, P ≤ .01.
*** Difference in trend in lipid testing between stage 0–1 CRC cases and controls is nonsignificant; between stage 2–3 CRC cases and controls, P ≤ .05; between stage 0–1 and stage 2–3 is nonsignificant.
††† Test for trend in lipid testing over time for stage 0–1 CRC cases is nonsignificant.
‡‡‡ Test for trend in lipid testing over time for stage 2–3 CRC cases is nonsignificant.
§§§ Test for trend in lipid testing over time for controls, P ≤ .001.
CRC, colorectal cancer; HgbA1c, hemoglobin A1c or glycosylated haemoglobin.
Variables Claim Type Medicare Claim Codes Mammography HCPCS/CPT 76090, 76091, 76092 Influenza vaccination HCPCS/CPT 90724, G0008, 90657–90660, Q0124 ICD-9-CM V048, V066 ICD-9-P 99.52 HgbA1c HCPCS/CPT 83036 Lipid testing HCPCS/CPT 80061, 80062, 82465, 82470, 83700, 83705, 83715–83721, 84478 Evidence of metastatic disease HCPCS/CPT 36246, 36247, 47120, 47122, 47125, 47130, 47370, 47371, 47380, 47381, 47382, 76362, 76394, 76490, 36260, 47100, C2618 ICD-9-CM 197.0, 197.00, 197.04, 197.08, 197.1, 197.2, 197.3, 197.7, 197.70, 197.8, 198.3, 198.4, 198.41, 198.45, 198.48, 198.5, 198.51 ICD-9-P 50.2, 50.20, 50.21, 50.22, 50.29, 50.3, 50.30, 50.4, 50.40 Recurrence treatment Chemotherapy: HCPCS/CPT 96408, 96410, 96412, 96414, 96520, 96530, 96545, 96549, J9190, J0640, J9200, Q0083, Q0084, Q0085 ICD-9-CM V58.1, E933.1, V66.2, V67.2 ICD-9-P 99.25 Radiation therapy: HCPCS/CPT 77261–63, 77280, 77285, 77290, 77295, 77299, 77300, 77305, 77310, 77315, 77321, 77326–8, 77331–4, 77336, 77370, 77399, 77401–17, 77419–32, 77470, 77490, 77499, 77750, 77761–3, 77776–8, 77781–4, 77789–90, 77797, 77799, ICD-9-CM V66.1, V67.1, V58.0 ICD-9-P 92.20–92.29 Revenue center 0333 HCPCS, Healthcare Common Procedure Coding System; CPT, Current Procedural Terminology; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-9-P, ICD-9-CM Procedure.
