Cancer Screening after the Adoption of Paid-Sick-Leave Mandates.
Cancer Screening after the Adoption of Paid-Sick-Leave Mandates.
复制标题
通过付费弹头命令后进行癌症筛查。
DOI：
10.1056/nejmsa2209197
复制
发表时间：
2023-03-02
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
到 2022 年底，美国近 2000 万工人已获得带薪病假，这些规定要求雇主向合格工人提供福利，包括使用预防性服务的带薪休假。尽管缺乏带薪病假可能会阻碍获得预防性护理，但目前的证据不足以就带薪病假与癌症筛查的关系得出有意义的结论。我们通过比较居住在受带薪病假规定（暴露的 MSA）影响的大都市统计区 (MSA) 的工人和居住在未暴露的 MSA 的工人之间 12 个月和 24 个月的结直肠癌筛查和乳房 X 光检查率的变化，研究了带薪病假规定与乳腺癌和结直肠癌筛查之间的关联。这些比较是使用 2012 年至 2019 年约 200 万私营部门员工的行政医疗索赔数据进行的。我们样本中的 61 个 MSA 中存在带薪病假规定。在强制规定通过之前，暴露和未暴露的 MSA 的筛查率相似。在调整后的分析中，居住在暴露的 MSA 的工人的癌症筛查率比未暴露的 MSA 的工人高 1.31 个百分点（95% 置信区间 [CI]，0.28 至 2.34），12 个月结直肠癌筛查，1.56 个百分点（95% CI，0.33 至 2.79），24 个月结直肠癌筛查，1.22 个百分点12 个月的乳房 X 光检查为 (95% CI，-0.20 至 2.64)，24 个月的乳房 X 光检查为 2.07 个百分点 (95% CI，0.15 至 3.99)。在美国私营部门工人样本中，居住在享有带薪病假规定的 MSA 中的癌症筛查率高于居住在未享受带薪病假规定的 MSA 中的工人。我们的研究结果表明，缺乏带薪病假覆盖对癌症筛查构成了障碍。 （由国家癌症研究所资助。）
By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, −0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.)