Influence of health insurance coverage on breast, cervical, and colorectal cancer screening in rural primary care settings

Authors

  • Patricia A. Carney PhD,

    Corresponding author
    1. Department of Family Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
    2. Department of Public Health and Preventive Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
    • Department of Family Medicine, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098

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    • Fax: (503) 494-2746

  • Jean O'Malley MPH,

    1. Biostatistics and Design Program, School of Medicine, Oregon Health and Science University, Portland, Oregon
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  • David I. Buckley MD, MPH,

    1. Department of Family Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
    2. Department of Public Health and Preventive Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
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  • Motomi Mori PhD,

    1. Department of Public Health and Preventive Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
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  • David A. Lieberman MD,

    1. Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
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  • Lyle J. Fagnan MD,

    1. Department of Family Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
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  • James Wallace BA,

    1. Department of Family Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
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  • Betty Liu MD, MPH,

    1. Department of Public Health and Preventive Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
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  • Cynthia Morris MPH, PhD

    1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
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Abstract

BACKGROUND:

The current study was performed to determine, in rural settings, the relation between the type and status of insurance coverage and being up-to-date for breast, cervical, and colorectal cancer screening.

METHODS:

Four primary care practices in 2 rural Oregon communities participated. Medical chart reviews that were conducted between October 2008 and August 2009 assessed insurance coverage and up-to-date status for breast, cervical, and colorectal cancer screening. Inclusion criteria involved having at least 1 health care visit within the past 5 years and being aged ≥ 55 years.

RESULTS:

The majority of patients were women aged 55 years to 70 years, employed or retired, and who had private health insurance and an average of 2.5 comorbid conditions. The overall percentage of eligible women who were up-to-date for cervical cancer screening was 30%; approximately 27% of women were up-to-date for clinical breast examination, 37% were up-to-date for mammography, and 19% were up-to-date for both mammography and clinical breast examination. Approximately 38% of men and 35% of women were up-to-date for colorectal cancer screening using any test at appropriate screening intervals. In general, having any insurance versus being uninsured was associated with undergoing cancer screening. For each type of screening, patients who had at least 1 health maintenance visit were significantly more likely to be up-to-date compared with those with no health maintenance visits. A significant interaction was found between having health maintenance visits, having any health insurance, and being up-to-date for cancer screening tests.

CONCLUSIONS:

Overall, the percentage of patients who were up-to-date for any cancer screening, especially cervical cancer screening, was found to be very low in rural Oregon. Patients with some form of health insurance were more likely to have had a health maintenance visit within the previous 2 years and to be up-to-date for breast, cervical, and/or colorectal cancer screening. Cancer 2012. © 2012 American Cancer Society.

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