Lack of insurance ’completely’ accounts for lower cancer screening rates among unemployed
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Unemployment appeared associated with a lower likelihood of having health insurance and of being up to date on cancer screening tests, according to results of a study published in Cancer.
Researchers also found a lack of insurance coverage completely accounted for the lower screening rates among unemployed adults in the study.
In addition, people unemployed at the time of the survey were less likely to be up to date with cancer screenings in the long term, suggesting unemployment at any point may hinder longer-term screening practices and potentially influence cancer outcomes.
“As unemployment rates rose during the COVID-19 pandemic, we wondered how this might influence cancer screening,” Stacey A. Fedewa, PhD, MPH, senior principal scientist of risk factors and screening surveillance research at American Cancer Society, told Healio. “Previous research has reported that unemployed persons have lower cancer screening utilization, but we couldn’t find a previous study that looked at the role of health insurance, too. We felt this was an important research question because health insurance among unemployed persons is potentially modifiable.”
Fedewa and colleagues examined associations among unemployment, health insurance and cancer screening to decipher the pandemic’s potential impacts on early cancer detection.
The analysis included 62,314 employed and 3,428 unemployed screening-eligible adults aged 50 to 64 years identified through the National Health Interview Survey. The majority of respondents in the employed and unemployed groups were men (51.9% vs. 53.9%) and white (75.5% vs. 64.2%), and a greater proportion of employed adults had private insurance (83.5% vs. 40.2%).
Fedewa and colleagues computed up-to-date and past-year screening prevalence for breast, cervical, colorectal and prostate cancers using survey data from 2000 to 2018, and evaluated self-reported past-week employment data from respondents. The researchers hypothesized that current unemployment may be more strongly associated with recent screening prevalence than up-to-date screening prevalence, reasoning that some tests recommended by the U.S. Preventive Services Task Force have longer intervals and that up-to-date screening may have been achieved prior to job loss. They defined up-to-date screening prevalence per USPSTF recommendations and used recent screening prevalence to assess proximal associations between screening practices and unemployment.
Recent (within the past year) and up-to-date breast, cervical, colorectal and prostate cancer screening prevalence served as the study’s primary outcomes.
Results showed unemployed adults had a four times higher likelihood of lacking insurance than employed adults (41.4% vs 10%) and that unemployed adults (vs. employed adults) had a significantly lower up-to-date prevalence of screening for cervical cancer (78.5% vs. 86.2%), breast cancer (67.8% vs. 77.5%), colorectal cancer (41.9 vs. 48.5%) and prostate cancer (25.4% vs. 36.4%; all P < .001).
Accounting for health insurance coverage negated the differences.
“I was somewhat surprised that insurance completely accounted for the association between unemployment and receipt of cancer screening tests,” Fedewa said. “We hypothesized that insurance might mitigate this association (ie, being unemployed and receipt of cancer screening), but I was not expecting insurance to fully account for the association.”
Researchers wrote that this finding is notable because it is potentially modifiable.
They concluded that extending health insurance for the unemployed could help combat the impact of unemployment — which has increased since the beginning of the COVID-19 pandemic —, on regular, up-to-date screening.
“Our research findings suggest that expanding and ensuring health insurance coverage after job loss may mitigate the COVID-19 pandemic’s economic impact, as well as the impact of future adverse economic events on cancer screening,” Fedewa told Healio.
Further studies would benefit from the ability to account for other factors related to employment and insurance in assessing impact on cancer screening, Fedewa added.
“We were not able to precisely examine the intersection of unemployment, Medicaid expansion/non-expansion, and receipt of cancer screening in this study because we did not have access to state-level data,” Fedewa said. “This will be important future research.”
For more information:
Stacey A. Fedewa, PhD, MPH, can be reached at American Cancer Society, 250 Williams St. NW, Atlanta, GA 30303; email: stacey.fedewa@cancer.org.
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