Abstract
BackgroundPopulations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer.The objectiveTo explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer.MethodsThe study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.9 million members. Utilization of breast cancer (BC) and colorectal cancer (CC) screening were analyzed by socio-economic ranks (SERs), ethnicity (Arab vs non-Arab), immigration status and ownership of voluntarily supplemental health insurance (VSHI).ResultsData on 157,928 and 303,330 adults, eligible for BC and CC screening, respectively, were analyzed. Those having lower SER, Arabs, immigrants from Former Soviet Union countries and non-owners of VSHI performed fewer cancer screening examinations compared with those having higher SER, non-Arabs, veterans and owners of VSHI (p < 0.001). Logistic regression model for BC Screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab and having a lower SER. The model for CC screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. The model estimated for BC and CC screening among females revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant.ConclusionPatients from low socio-economic backgrounds, Arabs, immigrants and those who do not own supplemental insurance do fewer tests for early detection of cancer. These sub-populations should be considered priority populations for targeted intervention programs and improved resource allocation.
Highlights
Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer.The objective: To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer
We analyzed 157,928 women who were eligible for breast cancer (BC) screening and 303,330 men and women who were eligible for CC screening tests
Utilization of mammography screening was more prevalent in the higher socio-economic ranks (SERs) (11-15, 16-20): 68.6% and 72.9%, respectively, compared to the lower ranks (1-5, 6-10): 64.1% and 65.6%, respectively (p < 0.001)
Summary
Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer.The objective: To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer. In 2001, the Institute of Medicine (IOM) declared that among other dimensions, quality of health care is defined by it being equitable, i.e., care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socioeconomic status [2]. This designation of equality as a dimension in quality of care reinforced the commitment of health organizations to reduce health disparities among all populations. A report published by the IOM in 2002 suggested that awareness of the health care gap be heightened among sectors that include health care providers, their patients and society at large [3]
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