Health Insurance Status and Clinical Cancer Screenings Among US Adults

Introduction: Health insurance coverage is linked to clinical preventive service use. This study examined cancer screenings among U.S. adults by health insurance status. Methods: The Behavioral Risk Factor Surveillance System collected data on healthcare access and cancer screenings from 42 states and the District of Columbia in 2014. Data analyses were conducted in 2016. Participants' health insurance status during the preceding 12 months was categorized as adequately insured, underinsured, or never insured. Primary type of insurance coverage was categorized as employer-based or Medicare (aged >= 65 years), self-purchased plan, Medicaid/ Medicare (aged < 65 years), and other public insurance. Clinical cancer screenings were assessed following the U.S. Preventive Services Task Force recommendations. Results: Compared with adequately insured adults, underinsured and never insured women were 6% (p < 0.001) and 41% (p < 0.001) less likely to receive breast cancer screening, respectively; 1% (p < 0.05) and 19% (p < 0.001) less likely to receive cervical cancer screening, respectively; and 3% (p < 0.01) and 47% (p < 0.001) less likely to receive colorectal cancer screening, respectively; underinsured and never insured men were 6% (p < 0.001) and 52% (p < 0.001) less likely to receive colorectal cancer screening, respectively. Compared with adults with employer-based insurance/Medicare (aged >= 65 years), women with all other types of insurance were less likely to receive breast and cervical cancer screenings; women and men with self-purchased plans were less likely to receive colorectal cancer screening; however, men with other public insurance were more likely to receive colorectal cancer screening. Conclusions: Disparities in cancer screenings by health insurance status and type of insurance exist among U.S. adults. Greater efforts to increase screening rates and to reduce disparities in cancer screenings are an important strategy to help improve overall population health. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine