健康保险中断与乳腺癌及结直肠癌筛查的关系
Association of health insurance coverage disruptions and breast and colorectal cancer screening
DOI 原文链接
用sci-hub下载
如无法下载，请从 Sci-Hub 选择可用站点尝试。
影响因子:5.1
分区:医学1区 Top / 肿瘤学2区
发表日期:2025 Jan 01
作者:
Kewei Sylvia Shi, Xuesong Han, Jessica Star, Jingxuan Zhao, K Robin Yabroff
DOI:
10.1002/cncr.35584
摘要
在美国，健康保险对于确保获得推荐的医疗服务至关重要。本研究探讨了健康保险中断（即保险变动）与乳腺癌及结直肠癌筛查的关系。研究对象为年龄在50-64岁、符合筛查年龄且未满65岁的成年人（乳腺癌n=17,128，结直肠癌n=32,562），数据来自全国健康访谈调查的五年期间。根据调查时的保险类型（私有、公共、无保险）及过去一年内的保险中断情况，将成人分为五组。筛查指标包括：是否曾接受筛查、过去一年内筛查以及符合指南的筛查。采用多变量逻辑回归分析保险中断与筛查之间的关系。调查时有保险的成年人中，3.1%的私有保险者和6.5%的公共保险者曾有保险中断。无保险者的筛查率最低。私有保险者中，保险中断与符合指南的筛查显著降低（调整后普遍比率[aPR]：乳腺癌0.82，95%CI：0.75-0.89；结直肠癌0.78，95%CI：0.72-0.86）；公共保险者中，保险中断亦与乳腺癌（aPR=0.73，95%CI：0.60-0.89）和结直肠癌（aPR=0.84，95%CI：0.72-0.99）符合指南的筛查降低相关。保险中断与过去一年内筛查和符合指南筛查皆呈显著相关。研究强调稳定的健康保险覆盖对于提高癌症筛查率和早期发现的重要性。
Abstract
Health insurance coverage is critical for ensuring access to recommended health care in the United States. This study investigated the associations of health insurance coverage disruptions, also known as coverage churn, and receipt of breast and colorectal cancer screening.Adults who were age-eligible and younger than 65 years (range, 50-64 years) for breast (n = 17,128 women) and colorectal (n = 32,562 individuals) cancer screening were identified from 5 years of the National Health Interview Survey. Adults were categorized into five groups based on insurance type at survey (private, public, none) and prior coverage disruptions within the past year. Screening outcomes included: (1) ever-screened, (2) past-year screening, and (3) guideline-concordant screening. Separate multivariate logistic regression models were used to evaluate the associations between insurance coverage disruptions and cancer screening.Among adults who had coverage at the time of the survey, 3.1% with private insurance and 6.5% with public insurance reported prior coverage disruptions. Individuals without health insurance coverage had the lowest level of screening. Among individuals who had private coverage, prior disruptions were associated with lower guideline-concordant screening in adjusted analyses (breast cancer screening: adjusted prevalence ratio [aPR], 0.82; 95% confidence interval [CI], 0.75-0.89; colorectal cancer screening: aPR, 0.78; 95% CI, 0.72-0.86); among those who had public coverage, prior disruptions were also associated with lower guideline-concordant breast cancer screening (aPR, 0.73; 95% CI, 0.60-0.89) and colorectal cancer screening (aPR, 0.84; 95% CI, 0.72-0.99).Health insurance coverage disruptions were associated with lower past-year and guideline-concordant breast and colorectal cancer screening. The current findings underscore the importance of stable health insurance coverage to improve cancer screening and early detection when treatment is most effective.