The importance of health insurance as a determinant of cancer screening: Evidence from the Women's Health Initiative

被引:206
作者
Hsia, J
Kemper, E
Kiefe, C
Zapka, J
Sofaer, S
Pettinger, M
Bowen, D
Limacher, M
Lillington, L
Mason, E
机构
[1] George Washington Univ, Dept Med, Washington, DC USA
[2] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[3] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA
[4] Vet Affairs Med Ctr, Birmingham, AL USA
[5] Univ Massachusetts, Sch Med, Dept Prevent & Behav Med, Worcester, MA USA
[6] CUNY Bernard M Baruch Coll, Sch Publ Affairs, New York, NY 10010 USA
[7] Univ Florida, Dept Med, Gainesville, FL USA
[8] Harbor UCLA Res & Educ Inst, Torrance, CA USA
[9] Cook Cty Hosp, Dept Obstet & Gynecol, Chicago, IL 60612 USA
基金
美国国家卫生研究院;
关键词
insurance coverage; neoplasm/prevention & control; health services accessibility;
D O I
10.1006/pmed.2000.0697
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background. Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initiative Observational Study cohort. Methods. Questionnaire data from 55,278 women enrolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years. Results. Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. Conclusions. In the Women's Health Initiative Observational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening independent of demographics, chronic health conditions, and self-perceived health characteristics. (C) 2000 American Health Foundation and Academic Press.
引用
收藏
页码:261 / 270
页数:10
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