Cancer
Colorectal Cancer Screening Initiation at Age 45 Among Texas Medicaid Enrollees, 2018–2021 Ami E. Sedani* Ami Sedani Sedani Sedani Sedani Sedani Sedani UTHealth Houston School of Public Health
Background: In 2018, the American Cancer Society recommended lowering the colorectal cancer (CRC) screening initiation age from 50 to 45 years, preceding Texas Medicaid coverage in 2021. This coverage gap left low-income adults without routine access despite guideline support. We examined CRC screening initiation at age 45 among Texas Medicaid enrollees during this period.
Methods: We conducted a retrospective cohort study using Texas Medicaid T‑MSIS Analytic Files (2018–2021). Enrollees who turned 45 years between May 2018 and December 2020 were included if they had ≥6 months continuous enrollment pre‑index (45th birthday), and ≥12 months post‑index. We excluded those dually eligible for Medicare, or at increased CRC risk per USPSTF criteria. Screening initiation was defined as completion of any recommended CRC test within 12 months post-index, identified using CPT/HCPCS codes. We summarized demographic and clinical characteristics, estimated initiation prevalence, and used multivariable logistic regression to assess adjusted associations between initiation and patient demographics, care utilization, and chronic condition burden.
Results: Of 10,874 enrollees, 3.7% initiated screening within 12 months post-index. Among screening initiators, most underwent direct visualization testing, predominantly colonoscopy (63.5%). Screening prevalence remained low across all years, with a slight increase from <1% in 2018 to 2.0% in 2020. Higher comorbidity burden was the strongest predictor of initiation (OR 4.68, 95% CI 3.32–6.60), while prior primary care visits (OR 1.43, 95% CI 1.14 – 1.79) and female sex (OR 1.39, 95% CI 1.11 – 1.74) showed smaller associations.
Conclusions: CRC screening uptake at age 45 among Texas Medicaid enrollees was extremely low during the coverage gap, even among those with prior primary care engagement. These findings highlight the need for policy alignment and targeted interventions to improve early screening in low-income populations.