Publication Details

Title :

The impact of travel time on colorectal cancer stage at diagnosis in a privately insured population


BMC Health Serv Res.

Impact Factor:



Alyabsi M1, Charlton M2, Meza J3, Islam KMM4, Soliman A5, Watanabe-Galloway S4.


1 Department of Population Health Research, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481, 1515, Saudi Arabia.

2 Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, Iowa, 52242, USA.

3 Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, 984375 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.

4 Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.

5 City University of New York School of Medicine, Community Health and Social Medicine, 160 Convent Avenue, New York, NY, 10031, USA.

Year of Publication:





Rural residents are less likely to receive screening for colorectal cancer (CRC) than urban residents. However, the mechanisms underlying this disparity, especially among people aged 50-64 years old with private health insurance, are not well understood. We examined the impact of travel time on stage at CRC diagnosis.

This retrospective cohort study used data from the Blue Cross and Blue Shield of Nebraska. Members of this private insurance company aged 50-64 years, diagnosed with CRC during the period 2012-2016, and continuously enrolled in the insurance plan for at least 6 months prior to CRC diagnosis, were selected for this study. Using Google Maps, we estimated patients’ travel time from their home ZIP code to the ZIP code of their colonoscopy provider. Using logistic regression, we analyzed the association between stage at CRC diagnosis, travel time, use of preventive services (i.e., check-ups or counseling to prevent or detect illness at an early stage) and patient characteristics.

A total of 307 subjects met the inclusion criteria. People who had not used preventive services 6 months prior to CRC diagnosis had 2.80 (95% CI, 1.00-7.90) times the odds of metastatic CRC compared to those who had used these services. No statistically significant association was found between travel time and metastatic CRC diagnosis (P = 0.99; 95% CI, 0.98-1.01).

The fact that 13% of the study population presented with metastatic CRC suggests some noncompliance with preventive services such as screening guidelines. To increase screening uptake and reduce metastatic cases, employers should offer incentives for their employees to make use of preventive services such as CRC screening.