title: The impact of Medicare eligibility on cancer screening behaviors.
abstract: BACKGROUND
  Lack of health insurance limits access to preventive services, including cancer screening. We examined the effects of Medicare eligibility on the appropriate use of cancer screening services in the United States.
  
  
  METHODS
  We performed a cross-sectional analysis of the 2012 Behavioral Risk Factor and Surveillance System (analyzed in 2014). Univariable and logistic regression analyses were performed for participants aged 60-64 and 66-70 to examine the effects of Medicare eligibility on prevalence of self-reported screening for colorectal, breast, and prostate cancers. Sub-analyses were performed among low-income (<$25,000 annual/household) individuals.
  
  
  RESULTS
  Medicare-eligible individuals were significantly more likely to undergo all examined preventive services (colorectal cancer OR: 1.90; 95% CI 1.79-2.04; prostate cancer OR: 1.29; 95% CI 1.17-1.43; breast cancer OR: 1.23; 95% CI 1.10-1.37) and the effect was most pronounced among low-income individuals (colorectal cancer OR: 2.04; 95% CI 1.8-2.32; prostate cancer OR: 1.39; 95% CI 1.12-1.72; breast cancer OR: 1.42, 95% CI 1.20-1.67). Access to a healthcare provider was the strongest independent predictor of undergoing appropriate screening, ranging from OR 2.73 (95% CI 2.20-3.39) for colorectal cancer screening in the low-income population to OR 4.79 (95% CI 3.95-5.81) for breast cancer screening in the overall cohort. The difference in screening prevalence was most pronounced when comparing Medicare-eligible participants to uninsured Medicare-ineligible participants (+33.2%).
  
  
  CONCLUSIONS
  Medicare eligibility impacts the prevalence of cancer screening, likely as a result of increased access to primary care. Low-income individuals benefit most from Medicare eligibility. Expanded public insurance coverage to these individuals may improve access to preventive services.
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Allard
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Julian
authors.initials: J
authors.lastname: Hanske
authors.affiliation: Department of Medicine, Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: McNabb-Baltar
authors.affiliation: Department of Surgery, Gastrointestinal and General Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Goldberg
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Gally
authors.initials: G
authors.lastname: Reznor
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Weissman
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: trinh.qd@gmail.com.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D057566:Self Report; D014481:United States
keywords: Breast cancer; Cancer screening; Cervical cancer; Colorectal cancer; Medicare; Preventive services; Prostate cancer; USPSTF