Association of health insurance coverage disruptions and breast, colorectal, and cervical cancer screening.

Abstract

116 Background: Health insurance coverage is critical for ensuring access to recommended health care in the United States. This study investigates the effects of insurance coverage disruptions on receipt of breast, colorectal, and cervical cancer screenings. Methods: We identified adults <65 years eligible for breast, cervical and/or colorectal cancer screening from the 2015, 2019, and 2021 National Health Interview Survey (years cancer control supplements fielded). Adults were categorized into 5 groups based on insurance type at survey and prior coverage disruptions (lack of insurance during prior 12 months): private, with and without disruption; public, with and without disruption; and uninsured. Screening outcomes included: 1) past-year screening and 2) guideline-concordant screening, defined from the US Preventive Services Task Force guidelines available at the time of each survey. Separate multivariate logistic regression models were used to evaluate the associations of insurance coverage disruptions and cancer screening. Results: We identified 12,121 women aged 50-64 years eligible for breast cancer screening, 23,490 people aged 50-64 years eligible for colorectal cancer screening, and 33,391 women aged 21-64 years eligible for cervical cancer screening. Compared to people with continuous private or public coverage, people with coverage disruptions were less likely to receive past-year or guideline-concordant cancer screening (Table). People without health insurance coverage had the lowest level of screening. Among people with private coverage, disruptions were associated with lower guideline-concordant screening across all three cancer types in adjusted analyses (breast: AOR: 0.45, 95% confidence interval (CI): (0.32, 0.63); colorectal: 0.49 (0.39, 0.62); cervical: 0.70 (0.58,0.84)); among people with public coverage, disruptions were associated with lower guideline-concordant breast cancer screening (AOR: 0.39 (0.23, 0.65)). Conclusions: Health insurance coverage disruptions were associated with lower past-year and guideline-concordant breast, colorectal, and cervical cancer screening. Findings underscore the importance of stable health insurance coverage as part of a comprehensive approach to improve cancer screening rates and early detection of cancers when treatment is most effective.[Table: see text]