Cost-effectiveness of Leveraging Social Determinants of Health to Improve Breast, Cervical, and Colorectal Cancer Screening

Mohan, Giridhar; Chattopadhyay, Sajal K.

doi:10.1001/jamaoncol.2020.1460

Cited by 51 publications

(43 citation statements)

References 46 publications

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“…In contrast, in two studies of patients treated in safety-net hospitals and integrated health care systems with equal access to care, racial disparities were not observed [ 20 , 32 ]. According to two recent systematic reviews, focused interventions to address social determinants of health are needed to improve cost-effective colorectal cancer screening in underserved, vulnerable populations, since factors such as poverty, lack of education, immigration status, lack of social support, and social isolation play a significant role in stage at diagnosis and overall survival [ 33 , 34 ]. Even though race and insurance appear to play a significant role in CRC care delivery and mortality as illustrated in this study, these factors do not fully explain the existing disparities.…”

Section: Resultsmentioning

confidence: 99%

The association of health insurance and race with treatment and survival in patients with metastatic colorectal cancer

et al. 2022

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Background Black patients and underinsured patients with colorectal cancer (CRC) present with more advanced disease and experience worse outcomes. The study aim was to evaluate the interaction of health insurance status and race with treatment and survival in metastatic CRC. Materials and methods Patients diagnosed with metastatic CRC within NCDB from 2006–2016 were included. Primary outcomes included receipt of chemotherapy and 3-year all-cause mortality. Multivariable logistic regression and Cox-regression (MVR) including a two-way interaction term of race and insurance were performed to evaluate the differential association of race and insurance with receipt of chemotherapy and mortality, respectively. Results 128,031 patients were identified; 70.6% White, 14.4% Black, 5.7% Hispanic, and 9.3% Other race. Chemotherapy use was higher among White compared to Black patients. 3-year mortality rate was higher for Blacks and lower for Hispanics, in comparison with White patients. By MVR, Black patients were less likely to receive chemotherapy. When stratified by insurance status, Black patients with private and Medicare insurance were less likely to receive chemotherapy than White patients. All-cause mortality was higher in Black patients and lower in Hispanic patients, and these differences persisted after controlling for insurance and receipt of chemotherapy. Conclusion Black patients and uninsured or under-insured patients with metastatic CRC are less likely to receive chemotherapy and have increased mortality. The effect of health insurance among Blacks and Whites differs, however, and improving insurance alone does not appear to fully mitigate racial disparities in treatment and outcomes.

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Section: Resultsmentioning

confidence: 99%

The association of health insurance and race with treatment and survival in patients with metastatic colorectal cancer

et al. 2022

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“…These disparities need to be addressed with community engagement. A systemic review of economic evaluations of interventions leveraging social determinants of health to improve breast, cervical, and colorectal cancer screening found that they appear to be cost-effective for underserved, disadvantaged populations in the United States [ 54 ]. Community residents’ and leaders’ engagement as equal partners in structural and systemic interventions is a must for cancer screening programs to address root causes of disparities [ 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Reduction in Standard Cancer Screening in 2020 throughout the U.S.

Dennis

Hsu

Arrington

2021

Cancers

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Cancer screening is an important way to reduce the burden of cancer. The COVID-19 pandemic created delays in screening with the potential to increase cancer disparities in the United States (U.S.). Data from the 2014–2020 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to estimate the percentages of adults who reported cancer screening in the last 12 months consistent with the U.S. Preventive Services Task Force (USPSTF) recommendation for cervical (ages 21–65), breast (ages 50–74), and colorectal cancer (ages 50–75) prior to the pandemic. Cancer screening percentages for 2020 (April–December excluding January–March) were compared to screening percentages for 2014–2019 to begin to look at the impact of the COVID-19 pandemic. Screening percentages for 2020 were decreased from those for 2014–2019 including several underserved racial groups. Decreases in mammography and colonoscopy or sigmoidoscopy were higher among American Indian/Alaskan Natives, Hispanics, and multiracial participants, but decreases in pap test were also highest among Hispanics, Whites, Asians, and African-Americans/Blacks. Decreases in mammograms among women ages 40–49 were also seen. As the 2020 comparison is conservative, the 2021 decreases in cancer screening are expected to be much greater and are likely to increase cancer disparities substantially.

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“…Therefore, the potential drivers of these disparities could be best conceptualized as social determinants of health (SDOH). In recognizing the importance of SDOH in cancer screening disparities, a recent systematic review highlighted the utility of interventions based on SDOH to promote preventive cancer screening ( Mohan and Chattopadhyay, 2020 ). Systemic racism also likely contributes to the lower cervical cancer screening practices of different racial/ethnic groups, where increasing trust with healthcare providers and implementing person-centered care are critical steps to increase cervical cancer screening uptake ( Fuzzell et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Persistent racial disparities in cervical cancer screening with Pap test

McDaniel

Hallam

Cadwallader

et al. 2021

Preventive Medicine Reports

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Given the racial disparities in cervical cancer screening, incidence, and mortality, the purpose of this study was to estimate cervical cancer screening behaviors through self-reported Pap testing among racial groups in the U.S. This cross-sectional study utilized the Behavioral Risk Factor Surveillance System (BRFSS) data to compare Pap testing behaviors among women of different racial groups. The BRFSS data from 2014, 2016, and 2018 were chosen because these were the most recent years of data capturing cervical cancer screening information. The primary outcome was self-reported Pap testing behavior (yes/no). Racial groups were analyzed with the original categorical responses for the race/ethnicity variable to investigate Pap testing behaviors across all racial groups. Statistical analyses included descriptive statistics and a multivariable binomial logistic regression model to assess differences of Pap testing by race after adjusting for covariates. Among the 538,218 females included, 88.81% (95% CI: 88.60–89.03) reported receiving a Pap test. Pap testing behaviors differed significantly between racial groups in 2014, 2016, and 2018 (p < 0.001 for all years). Compared to White women, Asians (OR: 0.169, 95% CI: 0.149–0.191), Native Hawaiians/other Pacific Islanders (OR: 0.339, 95% CI: 0.249–0.462), American Indians or Alaskan Natives (OR: 0.664, 95% CI: 0.532–0.829), Hispanics (OR: 0.726, 95% CI: 0.670–0.786), and other non-Hispanic races (OR: 0.439, 95% CI: 0.323–0.598) were significantly less likely to receive Pap test. Racial disparities in cervical cancer screening with Pap tests exist for Asians, Native Hawaiians/other Pacific Islanders, American Indians or Alaskan Natives, Hispanics, and other non-Hispanics.

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Cost-effectiveness of Leveraging Social Determinants of Health to Improve Breast, Cervical, and Colorectal Cancer Screening

Cited by 51 publications

References 46 publications

The association of health insurance and race with treatment and survival in patients with metastatic colorectal cancer

The association of health insurance and race with treatment and survival in patients with metastatic colorectal cancer

Reduction in Standard Cancer Screening in 2020 throughout the U.S.

Persistent racial disparities in cervical cancer screening with Pap test

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