Abstract
PL04-02
Studies examining the prevalence of cancer screening and other health behaviors among lower income populations often find much lower rates of uptake compared with middle and upper income populations. However, these studies are typically confounded by health insurance coverage, which is much more limited among lower income groups. There are some lower income subgroups that are insured, such as veterans and individuals who qualify for subsidized housing. As the nation continues its debate about universal health insurance coverage and states such as Massachusetts actually implement mandatory coverage laws, there are serious issues to consider in terms of defining the terms of insurance coverage and the meaning of “access”. Examination of the prevalence of preventive health measures among lower income groups that currently have health insurance provides important data to inform these efforts. This paper will look at participation in cancer screening and other preventive measures among low income, insured populations. In particular, data will be presented about CRC screening prevalence among a largely low income, racial and ethnic minority sample of adults living in subsidized housing, among which 97% have health insurance. Screening was measured by self-report via in-person interviews, with validation against the medical record for a small random sample. Overall, prevalence of current screening was 67%; 81% of those screened had a colonoscopy. Validation of self-report confirmed 73% of self-reported endoscopic screening. This data demonstrates a high level of screening by colonoscopy among a low income population with health insurance, and the limited importance of race/ethnicity as a predictor of screening when insurance coverage is available. The implications of this and other studies on decisions regarding provision of health insurance to low income populations as a means of addressing persistent disparities in screening rates will be discussed.
First AACR International Conference on the Science of Cancer Health Disparities-- Nov 27-30, 2007; Atlanta, GA