Lack of health insurance directly reduces cancer screening rates, most recent and long-term

Unemployment rates hit a record high in April of 2020 as the largest 1-month increase in history¹, and quickly caught up to rates seen during the Great Depression.² With employers as the most common source of health insurance among adults, these rates were undoubtedly worrisome. What might the implications of the pandemic be on early cancer detection? Did loss of employment impact the public’s access to cancer screening?

Researchers from the American Cancer Society (ACS) searched for the answers. Their findings were published online today in the peer-reviewed journal Cancer.³

Using data from 2000-2018 National Health Interview Survey, an ACS research team investigated potential relationships between unemployment, health insurance, and cancer screening among nonelderly adults (under age 65) in the United States. They concluded that unemployment, thereby a lack of health insurance, was directly related to the low screening rates.

The team used survey data to compute up-to-date and past-year breast, cervical, colorectal, and prostate cancer screening prevalence among nonelderly respondents. They used multivariable logistic regression models with marginal probabilities to estimate unemployed versus employed unadjusted and adjusted prevalence ratios.

Unemployed adults were 4 times less likely to have health insurance than employed adults (41.4% vs 10.0%, P<.001) and had significantly lower up-to-date prevalence of all cancer screenings: cervical (78.5% vs 86.2%; P < .001), breast (67.8% vs 77.5%; P < .001), colorectal (41.9 vs 48.5%; P < .001), and prostate (25.4% vs 36.4%; P < .001). Researchers noted that these differences were eliminated after accounting for health insurance coverage.

Unemployed adults were also less likely to be up to date with their long-term screenings. “This suggests that being unemployed at a single point in time may hinder both recent and potentially longer-term screening practices,” researcher Stacy Fedewa, PhD, said in a press release.⁴

The findings are critical because outdated or missed cancer screenings can increase a person’s risk of being diagnosed with late-stage cancer, which is more difficult to treat than cancer detected at an early stage.

“Our finding that insurance coverage fully accounted for unemployed adults’ lower cancer screening utilization is potentially good news, because it’s modifiable,” Fedewa added.

The research team concluded that, by ensuring the continuation of health insurance coverage after a job loss, we may be able to mitigate the pandemic’s economic distress and reduce any future economic downturns’ impact on cancer screening.

The study indicates a need for health insurance offerings to include all people regardless of employment status.

References

1. Jones C. 3 Reasons Unemployment Is Already At Great Depression Levels. Forbes. https://www.forbes.com/sites/chuckjones/2020/05/19/3-reasons-unemployment-is-already-at-great-depression-levels/?sh=7331762e413f. Published January 11, 2021. Accessed November 5, 2021.
2. Iacurci G. Unemployment is nearing Great Depression levels. Here’s how the eras are similar — and different. CNBC. Published May 19, 2020. Accessed November 5, 2021. https://www.cnbc.com/2020/05/19/unemployment-today-vs-the-great-depression-how-do-the-eras-compare.html
3. Fedewa SA, Yabroff KR, Bandi P, et al. Unemployment and cancer screening: Baseline estimates to inform health care delivery in the context of COVID‐19 economic distress. Cancer. Published online November 8, 2021. doi:10.1002/cncr.33966
4. Lack of health insurance hinders recommended cancer screening in unemployed adults. Wiley.com. Published 2021. Accessed November 8, 2021. https://newsroom.wiley.com/press-releases/press-release-details/2021/Lack-of-health-insurance-hinders-recommended-cancer-screening-in-unemployed-adults/default.aspx