健康保险覆盖范围中断和乳腺癌和结直肠癌筛查的关联
Association of health insurance coverage disruptions and breast and colorectal cancer screening
影响因子:5.10000
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
摘要
健康保险对于确保美国获得推荐的医疗保健至关重要。这项研究调查了健康保险覆盖中断的关联，也称为覆盖范围，并接受了乳腺癌和结直肠癌筛查的接收。年龄符合年龄且年轻的65岁以下（范围为50-64岁）的乳房（n = 17,128）（n = 17,128）女性和结直肠病（n = 32,562个人）（n = 32,562个个人）癌症筛查是5年的评估。根据调查的保险类型（私人，公共，无）和过去一年中的事先承保范围中断，将成年人分为五组。筛选结果包括：（1）筛选，（2）过去一年的筛选和（3）指南协调筛选。使用单独的多元逻辑回归模型来评估保险范围中断和癌症筛查之间的关联。在调查时有保险的成年人，有3.1％的私人保险和6.5％的公共保险报告事先覆盖范围中断。没有健康保险的个人的筛查水平最低。在具有私人覆盖范围的个体中，先前的中断与调整后的分析中的指导原则筛查相关（乳腺癌筛查：调整后的患病率[APR]，0.82; 95％置信区间[CI]，0.75-0.89，大肠癌筛查；大肠癌筛查：APR，0.78; 95％CI，0.72-0.86）; 95％CI，0.72-0.86）;在那些拥有公共报道的人中，先前的中断还与较低的指导条件乳腺癌筛查有关（APR，0.73; 95％CI，0.60-0.89）和结直肠癌筛查（APR，0.84; 95％CI，0.72-0.99）。健康保险覆盖率较低，与较低的保险范围相关。目前的发现强调了稳定的健康保险覆盖范围对于改善癌症筛查和早期检测的重要性。
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.