Paid-sick-leave mandates linked to higher cancer screening rates
Private sector workers in the United States had a higher likelihood of undergoing colorectal or breast cancer screening if they lived in a jurisdiction with a paid-sick-leave mandate, results of a population-based study showed.
Researchers estimated that implementation of paid-sick-leave mandates led to approximately 298,625 new colorectal cancer screenings and 249,559 mammograms over a 24-month period.
The findings — published in The New England Journal of Medicine — suggest a lack of paid-sick-leave coverage could serve as a barrier to cancer screening, the investigators noted.
“Oftentimes we focus on expanding insurance coverage when discussing ways to increase access to care, and there are clear barriers to accessing care — especially preventive care — that are in addition to insurance coverage,” Kevin Callison, PhD, assistant professor in the department of health policy and management at Tulane University School of Public Health and Tropical Medicine, told Healio. “Policies that improve workplace flexibility can lead to meaningful increases in screening and the use of preventive services.”
Background
Responses at a focus group examining why women did not participate in routine mammography motivated creation the study. Some of the most frequent and thought-provoking responses centered around inability to get time off from work for routine screening, especially paid time off, according to Callison.
“That really got us thinking about barriers to access and care that are outside of insurance coverage or the list price for the cost of the services,” he said. “Especially for something like colorectal cancer screening — which takes preparation — we thought that there may be some link between workplace flexibilities, such as paid sick leave, and access to these services.”
Methodology
Callison and colleagues analyzed administrative medical claims data for approximately 2 million private-sector employees from 2012 through 2019 to identify any association between paid-sick-leave mandates and changes in cancer screening rates.
The researchers collected data on mammography and colorectal cancer screening, sex, age and metropolitan statistical area (MSA) of residence. They compared changes in 12- and 24-month rates of colorectal cancer screening and mammography between workers residing in MSAs affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs.
Key findings
The study sample included 61 MSAs with paid-sick-leave mandates.
Investigators reported similar screening rates for both breast and colorectal cancer within exposed vs. unexposed MSAs before adoption of sick leave mandates.
A multivariate-adjusted analysis showed uniformly higher cancer screening rates among workers residing in exposed MSAs compared with workers from unexposed MSAs, including:
- 1.31 percentage points higher (95% CI, 0.28-2.34) for 12-month colorectal cancer screening;
- 1.56 percentage points higher (95% CI, 0.33-2.79) for 24-month colorectal cancer screening;
- 1.22 percentage points higher (95% CI, 0.2 to 2.64) for 12-month mammography; and
- 2.07 percentage points higher (95% CI, 0.15-3.99) for 24-month mammography.
In areas that implemented mandates during the study, an adjusted model analysis showed a 5.9% relative increase in colorectal cancer screening rates at 24 months compared with the pre-mandate rate. Likewise, the adjusted model analysis showed a 3.3% relative increase in mammograms at 24 months compared with the pre-mandate rate.
Clinical implications
The percentage-point increases in cancer screenings after implementation of paid-sick-leave mandates may seem marginal, but that’s because the data account for the entire population being subjected to a new mandate, many of whom already had paid sick leave as part of their compensation packages, Callison said.
“We think these changes in screening are being driven by the people who are actually gaining paid sick leave,” he told Healio. “If that is true, we can scale these estimates by the share of people who gain paid sick leave when a mandate is adopted.”
A previous study by Callison and colleagues estimated that 28% of the population has been affected by new mandates and drives the increase in screening utilization.
“Under the assumption that only those 28% of people are driving the change in the screening, we see an approximate 9% to 12% increase in screening mammography and a 21% to 29% increase in colorectal cancer screening — so the effects are much bigger,” he said.
Cancer screening rates have been historically suboptimal, according to Callison.
“There's been a lot of efforts to improve cancer screening rates ... and I think this is another tool to improve adherence,” he said.
For more information:
Kevin Callison, PhD, can be reached at School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 1900, New Orleans, LA 70112; email: kcallison@tulane.edu.
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