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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: Noncitizens had substantially lower rates of breast, cervical and colorectal cancer screening. Many of the barriers to screening may only be solvable with systemic intervention or improved public health policy. Patients in the United States who are not U.S. citizens are much less likely to get screened for breast, cervical and colorectal cancers, highlighting structural barriers to care, according to experts. Jenny S. Guadamuz, MSPH, PhD, an assistant professor of health policy and management at University of California, Berkeley, School of Public Health, and colleagues recently published a cross-sectional study in JAMA Network Open to evaluate cancer screening equity associated with citizenship status.
Using nationally representative data and USPSTF guidelines, Guadamuz, also the health equity program director for UC Berkeley\u2019s Center for Health Management and Policy Research screening services, and colleagues measured how often immigrants without U.S. citizenship received breast, colorectal and cervical cancer screening services. They found that noncitizens had significantly lower cancer screenings for all three types studied than U.S.-born citizens: breast cancer rates \u2014 73% (95% CI; 66.4%-78.7%) for noncitizens and 80.1% (95% CI; 78.8%-81.3%) for citizens; cervical cancer rates \u2014 57.1% (95% CI; 53.1%-61%) for noncitizens and 71.6% (95% CI; 70.3%-72.8%) for citizens; and colorectal cancer rates \u2014 43.6% for noncitizens (95% CI; 38.7%-48.4%) and 75.5% for citizens (95% CI; 74.6%-76.5%). The researchers wrote that the disparities occurred in many states and throughout the study period. Noncitizens also saw significantly lower odds for receiving the screenings than citizens born in the U.S.: OR = 0.57 (95% CI; 0.52-0.62) for breast cancer screening; OR = 0.41 (95% CI; 0.38-0.44) for cervical cancer screening; and OR = 0.35 (95% CI; 0.32-0.38) for colorectal cancer screening. Together, healthcare and socioeconomic factors mediated those inequities (proportion mediated rates were 97.1% [95% CI, 87.1%-107.1%] for breast cancer; 39.6% [95% CI, 32.3%-47%] for cervical cancer; and 56.6% [95% CI, 49.1%-64.2% for colorectal cancer). Healio spoke with Guadamuz to learn about the study, what can be done to close the screening gap and more. Healio: Why did you decide to research this subject? Why is it important for healthcare professionals to know about? Guadamuz: I decided to focus on citizenship and ask what it means for access to cancer screening because \u2014 and specifically in these three types of cancers \u2014 over the last couple decades, deaths in these cancers have declined sharply. This is primarily driven not only by new treatments, but by the fact that they\u2019re being diagnosed at earlier stages when they are more treatable. But we also know that because of the health and immigration systems we have in the U.S., certain populations don\u2019t have equitable access to these screening services, which have really clear implications for how people are diagnosed with cancer, when they\u2019re diagnosed with cancer, and, ultimately, when they die, how they die. If someone is diagnosed at a late stage of any of these three types of cancer, their survival drops, and they end up dying a very unjust death because oftentimes these catches are very treatable. Healio: What are the barriers to access here? What are the consequences? Guadamuz: It\u2019s a bit of a gimme. Once you know how healthcare for citizens and noncitizen works in the U.S., it was pretty evident that you would find this inequity consistently and of this magnitude. That being said, the No. 1 cause is the fact that noncitizens have much lower access to health insurance and much less access to a usual source of care, like a primary care provider or some other type of regular provider who can notice that someone has a history of certain types of diseases that need screening, or who simply just follows the clinical guidelines and says, \u201cOh, this person reached 45, they need to go get the screening.\u201d Those are the No. 2 biggest causes. And this is the mediation analysis that led to these inequities that we observed. But the other things that were really important were economic barriers, so having lower incomes. I talk about this in the discussion of my manuscript as I\u2019m trying to interpret the findings: these screenings, even if you\u2019re insured, can be time-consuming and expensive because you have to take off work. For example, a colonoscopy requires you to take off the whole day, and we know from the literature that noncitizens, on average, have jobs with limited flexibility in terms of taking paid time off. So, the barriers to these screenings were really structural barriers. We didn\u2019t really find that things like language proficiency or years in the U.S. \u2014 these measures of how well a person has integrated into the U.S. society \u2014 led to the differences. They are important for clinicians to think about, but it was really caused by lower health insurance, lower healthcare access and worse socioeconomic conditions for noncitizens. Healio: What can be done to improve cancer screening (and other preventive healthcare) in this population? Guadamuz: The No. 1 thing we can do \u2014 we being the medical community, the public health community \u2014 is advocate for more inclusive health coverage policies. For example, California, albeit temporarily, expanded health insurance for undocumented immigrant adults. About 50% of noncitizens are undocumented or have some status that boots them from health insurance. They could be, for example, on a work visa \u2014 a noncitizen but not undocumented \u2014 and they still don\u2019t have access to health coverage from the public system. So, that\u2019s No. 1. There\u2019s also healthcare access programs that can be implemented. As one example, essentially the county<\/p>\n","protected":false},"author":1,"featured_media":3631,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3630","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3630","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3630"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3630\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3631"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3630"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3630"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3630"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}