Influence of health insurance coverage on breast, cervical, and colorectal cancer screening in rural primary care settings.
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.
Department of Family Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon 97239-3098, USA. carneyp@ohsu.edu
Patricia A
PA
Carney
Jean
J
O'Malley
David I
DI
Buckley
Motomi
M
Mori
David A
DA
Lieberman
Lyle J
LJ
Fagnan
James
J
Wallace
Betty
B
Liu
Cynthia
C
Morris
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011320:Primary Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control