The importance of health insurance as a determinant of cancer screening: Evidence from the Women's Health Initiative
The importance of health insurance as a determinant of cancer screening: Evidence from the Women's Health Initiative
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DOI：
10.1006/pmed.2000.0697
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发表时间：
2000-09-01
影响因子：
5.1
通讯作者：
Mason, E
中科院分区：
文献类型：
--
作者：
Hsia, J;Kemper, E;Mason, E
背景在目前美国医疗保健服务的变化中，健康保险状况和保险类型相对于人口统计学，实际和感知健康变量作为乳腺癌，结直肠癌和宫颈癌筛查的决定因素的重要性尚不确定。该分析评估了健康保险独立预测妇女健康倡议观察性研究队列中癌症筛查的假设。对1994年9月至1997年2月参加妇女健康倡议观察性研究的55，278名妇女的问卷调查数据进行多元逻辑回归分析，以确定2年内自我报告的乳房X线检查、3年内的巴氏涂片检查和5年内的粪便愈创木脂或乙状结肠软镜检查的预测因素。报告癌症筛查的积极决定因素是年龄，种族，家庭收入，教育水平，癌症家族史，有一个通常的护理提供者，自上次提供者访问的时间，以及保险状态和类型。吸烟、糖尿病和老年妇女中既往心血管事件是癌症筛查的负面决定因素。在65岁以下的女性中，缺乏健康保险或有收费服务保险与未能报告癌症筛查密切相关，独立于是否有或使用常规护理提供者以及人口统计学，自我感知健康和健康特征。在65岁及以上的妇女中，那些单独使用医疗保险的妇女报告癌症筛查的可能性较小，而那些使用医疗保险+预付保险的妇女报告癌症筛查的可能性较大。在妇女健康倡议观察性研究中，一个庞大的、多样化的老年妇女群体、健康保险类型和状况是癌症筛查的最重要决定因素，与人口统计学、慢性健康状况和自我感知的健康特征无关。(C)2000美国健康基金会和学术出版社。
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 Initiative Observational Study cohort.Methods. Questionnaire data from 55,278 women enrolled 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 Observational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening independent of demographics, chronic health conditions, and self-perceived health characteristics. (C) 2000 American Health Foundation and Academic Press.