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dc.contributor.authorHsia, Judith
dc.contributor.authorKemper, Elizabeth
dc.contributor.authorKiefe, Catarina I.
dc.contributor.authorZapka, Jane G.
dc.contributor.authorSofaer, Shoshanna
dc.contributor.authorPettinger, Mary
dc.contributor.authorBowen, Deborah
dc.contributor.authorLimacher, Marian C.
dc.contributor.authorLillington, Linda
dc.contributor.authorMason, Ellen
dc.date2022-08-11T08:10:35.000
dc.date.accessioned2022-08-23T17:13:24Z
dc.date.available2022-08-23T17:13:24Z
dc.date.issued2000-08-31
dc.date.submitted2010-04-27
dc.identifier.citationPrev Med. 2000 Sep;31(3):261-70. <a href="http://dx.doi.org/10.1006/pmed.2000.0697">Link to article on publisher's site</a>
dc.identifier.issn0091-7435 (Linking)
dc.identifier.doi10.1006/pmed.2000.0697
dc.identifier.pmid10964640
dc.identifier.urihttp://hdl.handle.net/20.500.14038/46721
dc.description.abstractBACKGROUND: Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort. METHODS: Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years. RESULTS: Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. CONCLUSIONS: In the Women's Health Initiative Obser vational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening indepen dent of demographics, chronic health conditions, and self-perceived health characteristics.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=10964640&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1006/pmed.2000.0697
dc.subjectAge Factors
dc.subjectAged
dc.subjectBreast Neoplasms
dc.subjectColorectal Neoplasms
dc.subjectCross-Sectional Studies
dc.subjectFemale
dc.subjectHealth Services Accessibility
dc.subjectHumans
dc.subjectInsurance Coverage
dc.subjectInsurance, Health
dc.subjectLogistic Models
dc.subjectMass Screening
dc.subjectMedicare
dc.subjectMiddle Aged
dc.subjectPredictive Value of Tests
dc.subjectQuestionnaires
dc.subjectSocioeconomic Factors
dc.subjectUnited States
dc.subjectUterine Cervical Neoplasms
dc.subject*Women's Health
dc.subjectBioinformatics
dc.subjectBiostatistics
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleThe importance of health insurance as a determinant of cancer screening: evidence from the Women's Health Initiative
dc.typeJournal Article
dc.source.journaltitlePreventive medicine
dc.source.volume31
dc.source.issue3
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/118
dc.identifier.contextkey1287863
html.description.abstract<p>BACKGROUND: Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort.</p> <p>METHODS: Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years.</p> <p>RESULTS: Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening.</p> <p>CONCLUSIONS: In the Women's Health Initiative Obser vational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening indepen dent of demographics, chronic health conditions, and self-perceived health characteristics.</p>
dc.identifier.submissionpathqhs_pp/118
dc.contributor.departmentDepartment of Medicine, Division of Preventive and Behavioral Medicine
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages261-70


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