Investigators have found that U.S. individuals with a history of incarceration may have worse access to and receipt of breast cancer and colorectal cancer screenings compared with those without a history of incarceration, according to a recent study published by Zhao et al in JAMA Health Forum.
Background
“Our study results were not surprising, as [individuals] with a history of incarceration experience barriers in access to health care in the [United States],” explained lead study author Jingxuan Zhao, MPH, Senior Associate Scientist of Health Services Research at the American Cancer Society (ACS).
Study Methods and Results
In the recent study, the investigators used the 2008 to 2018 National Longitudinal Survey of Youth 1979 cohort to identify individuals with and without a history of incarceration. They then measured patient-reported access to and receipt of usual sources of care and preventive services—including physical exams; influenza shots; blood pressure, blood cholesterol, and blood sugar tests; dental checkups; and colorectal cancer, breast cancer, and cervical cancer screenings. Separate multivariable models examining the associations between incarceration history and receipt of each preventive service were adjusted for key sociodemographic factors; sequential models were further adjusted for educational attainment and health insurance coverage to determine their contribution to the correlation.
The investigators demonstrated that the individuals with an incarceration history had a lower rate of usual sources of care as well as recommended preventive services, including physical exams (69.6% vs 74.1%), blood pressure tests (85.6% vs 91.6%), blood cholesterol tests (59.5% vs 72.2%), blood sugar tests (61.4% vs 69.4%), dental checkups (51.1% vs 66.0%), breast cancer screenings (55.0% vs 68.2%), and colorectal cancer screenings (65.6% vs 70.3%). With additional adjustment for educational attainment and health insurance, the associations of incarceration history and access to care were attenuated for most measures.
Conclusions
“[T]he findings further highlight the need for efforts to identify interventions to help increase receipt of recommended preventive services for this vulnerable population,” Ms. Zhao emphasized. “Improving access to education at a young age and health insurance coverage might help mitigate the disparities in access to care among [individuals] with an incarceration history,” she added.
The ACS Cancer Action Network (CAN) supports polices that help improve access to affordable, quality health coverage such as expanding Medicaid in the 10 states that have not done so. Access to Medicaid helps prevent health coverage gaps to ensure that all patients have access to the care they need, including preventive services, cancer screenings, and cancer treatment.
"Affordable health insurance is critical for everyone. As this study demonstrates, health insurance is a critical factor to reduce disparities in cancer screening for [individuals] who have been incarcerated,” underscored Lisa A. Lacasse, MBA, President of the ACS CAN. “Medicaid is an important source of health insurance for thousands of [individuals] who would not otherwise have access to care, including those who have been released from incarceration and are transitioning back to their communities. We urge lawmakers in these 10 states [that] have not expanded Medicaid to do so and help save more lives from cancer,” she concluded.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
