Understanding the role of access in Hispanic cancer screening disparities

Abstract

Background: Hispanic populations in the United States experience numerous barriers to care access. It is unclear how cancer screening disparities between Hispanic and non-Hispanic White individuals are explained by access to care, including having a usual source of care and health insurance coverage. Methods:A secondary analysis of the 2019 National Health Interview Survey was conducted and included respondents who were sex-and age-eligible for cervical (n = 8316), breast (n = 6025), or colorectal cancer screening (n = 11,313). The proportion of ever screened and up to date for each screening type was compared.Regression models evaluated whether controlling for reporting a usual source of care and type of health insurance (public, private, none) attenuated disparities between Hispanics and non-Hispanic White individuals.Results: Hispanic individuals were less likely than non-Hispanic White individuals to be up to date with cervical cancer screening (71.6% vs. 74.6%) and colorectal cancer screening (52.9% vs. 70.3%), but up-to-date screening was similar for breast cancer (78.8% vs. 76.3%). Hispanic individuals (vs. non-Hispanic White) were less likely to have a usual source of care (77.9% vs. 86.0%) and more likely to be uninsured (23.6% vs. 7.1%). In regressions, insurance fully attenuated cervical cancer disparities. Controlling for both usual source of care and insurance type explained approximately half of the colorectal cancer screening disparities (adjusted risk difference: −8.3 [-11.2 to -4.8]). Conclusion:Addressing the high rate of uninsurance among Hispanic individuals could mitigate cancer screening disparities. Future research should build on the relative successes of breast cancer screening and investigate additional barriers for colorectal cancer screening. Plain language summary� This study uses data from a national survey to compare cancer screening use those who identify as Hispanic with those who identify as non-Hispanic White.� Those who identify as Hispanic are much less likely to be up to date with colorectal cancer screening than those who identify as non-Hispanic White, slightly less likely to be up to date on cervical cancer screening, and similarly likely to receive breast cancer screening.

Engaging Community–Academic Partnerships: A Case Study of the Influence of Social Drivers of Health on Equitable Transitions of Cancer Care in the United States

“…An example is tailoring a colon cancer screening to fit a community's cultural and social norms. Hispanic men have high rates of colon cancer and yet the lowest rate of colon cancer screening [22]. The system needed to improve the screening program implementation for this group will look different than other groups.…”

How Culture Impacts Health: The Hispanic Narrative

“…Improving cultural sensitivity and health literacy are necessary to increase Hispanic people's access to and use of health services in managing chronic illnesses, promoting healthy lifestyles, preventing obesity, fostering workplace safety, and encouraging the use of screening and preventive services (Spencer et al, 2023; Velasco-Mondragon et al, 2016). For health-care providers, listening and observing are indispensable tools for assessing Hispanic patients, and for building open communication with patients and their families to allow for effective teaching and care (Johnson & Farquharson, 2019).…”

“…Cultural insensitivity by health-care providers poses serious threats to Hispanic patients who may avoid preventive counseling. Hispanic patients are less likely to be screened for cervical and colorectal cancer (Castillo et al, 2021; Spencer et al, 2023), have less follow-up care, and are more likely than Non-Hispanic Whites to receive mental health care through Emergency Departments rather than outpatient services (Velasco-Mondragon et al, 2016). Given the high prevalence of diabetes and obesity within the Hispanic population, it is discouraging to learn that only 20% of Hispanic patients reported that their providers had discussed diet and exercise with them within the previous year (Velasco-Mondragon et al, 2016).…”

Racial and Ethnic Disparities in Use of Colorectal Cancer Screening Among Adults With Chronic Medical Conditions: BRFSS 2012–2020

“…CRC screening guidelines are strongly supported by ef-fectiveness data, but use of screening in the US is suboptimal (2)(3)(4)(5). In 2022, the percentage of Hispanic adults who reported being up to date with CRC screening was lower (61.7%) than among non-Hispanic White (74.6%) and non-Hispanic Black (75.3%) adults (6). In addition, being male, having a low level of education, living in poverty, lacking health insurance, and using English as a second language have been associated with lower rates of CRC screening (7)(8)(9)(10).…”