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Early and Late-Onset Colorectal Cancer in Kentucky: Understanding Risk Factors and Comorbidities

This study examines the risk factors, comorbidities, and screening test use among early and late-onset colorectal cancer patients in Kentucky. By analyzing health administrative claims-linked cancer registry data, the study provides insights into the trends and potential predictors of CRC in the region.

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Early and Late-Onset Colorectal Cancer in Kentucky: Understanding Risk Factors and Comorbidities

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  1. Early- and late-age onset colorectal cancer in Kentucky: using health administrative claims-linked cancer registry data to better understand risk factors and comorbidities Julie S. Townsend, MS Epidemiologist, Division of Cancer Prevention and Control NAACCR/IARC Conference June 13, 2019

  2. CRC in Kentucky • Collaborative and strategic efforts to expand CRC screening across the state • Incidence rates peaked in 2001 at 64.0 per 100,000 • Lowest incidence rates in 2015 at 48.4 per 100,000 • Considerable progress in reducing overall CRC incidence rates

  3. Background Early-onset Colorectal Cancer (CRC): diagnosed before age 50 years In the United States, incidence and death rates for colorectal cancer (CRC) have been increasing in persons aged <50 years Relatively rare among persons aged < 50 years: 7.6 cases per 100,000 in the US from 2011 – 2015 Highest incidence rates over past 5 years in Kentucky (9.6 per 100,000) among persons < 50 years

  4. CRC Risk Factors

  5. Purpose • Study Question To better understand these trends, we sought to examine risk factors, comorbidities, and screening test use among Kentucky CRC patients

  6. Methods • Years: 2007 – 2011 • Registry data probabilistically linked to claims data from a set of public (including Medicare and Medicaid), state employee database, and private Kentucky insurers • Inclusion criteria: • First primary CRC cases • Continuously enrolled for one year prior to their cancer diagnosis • Had at least 1 claim • ICD 9 and CPT codes from claims data captured chronic conditions, screening test use, and risk factors • Captured within 1 year prior diagnosis • Descriptive analysis in SAS comparing early-onset to late-onset CRC patients • Demographic and tumor characteristics • Comorbidities, CRC risk factors, family history of CRC • Screening test use • Average time from screening to diagnosis confirmation, to initial treatment • Data linkages between Kentucky Cancer Registry and health administrative claims data

  7. Results • Kentucky, 2007 - 2011

  8. Early-onset CRC patients were more frequently male, had rectal cancer, and no other comorbidities

  9. However, these differences among early- and late-onset patients were not drastically different Regional and distant stage tumors were more common among early-onset CRC patients

  10. There was considerable variation in mean time to diagnosis in both age groups Mean time to diagnosis and treatment did not differ among early- and late-onset CRC patients in Kentucky

  11. Late-onset CRC patients had higher prevalence of diabetes, hypertension, and poor lipid profiles Family history of CRC, IBD, obesity, and use of smoking cessation medications were more common among early-onset CRC patients

  12. Early-onset CRC patients more frequently had colonoscopy

  13. Limitations • Obesity prevalence based on claims data was severely underestimated • Examined risk factors in the year prior to diagnosis, so long term history was not collected • May affect obesity prevalence, because weight loss associated with advanced CRC • Difficult to discern screening colonoscopy vs. diagnostic colonoscopy • Excluded the uninsured • The primary purpose of claims data is for billing, so it can’t always address every research question

  14. Summary • Claims data useful to identify comorbidities and screening test use • The linkage included Medicaid and privately insured patients • In Kentucky, early-onset CRC patients more frequently had obesity, family history of CRC, and IBD than older counterparts • Diabetes and tobacco-use history both relatively common in early- and late-onset CRC patients • These findings indicate that many early-onset CRC patients may be at risk for a second cancer given their history of obesity, diabetes, and tobacco use • Improved recognition of these risk factors in people under age 50 may allow for healthcare discussions about starting screening earlier, if appropriate • Supplementing cancer registry data with claims data has many benefits

  15. Acknowledgements:Kentucky Cancer RegistryBin Huang, DrPHQuan Chen, DrPHEric Tai, MD, MS

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