Research Mentor Name

Ammar Sukari

Research Mentor Email Address

sukaria@karmanos.org

Institution / Department

Wayne State University School of Medicine

Document Type

Research Abstract

Research Type

publichealth

Level of Research

yes

Type of Post-Bachelor Degree

MD candidate at WSUSOM, Class of 2025

Abstract

Background:

The Covid-19 pandemic has challenged healthcare access, jeopardizing cancer-related health measures. However, pandemic-era health policies led to increased health insurance coverage across most counties in the United States. This study aims to explore relationships between uninsured rates and cancer prevalence and screening behaviors.

Methods:

Data were collected from the CDC’s PLACES datasets for the 2021 (collected 2018-2019) and 2024 (collected 2022) release years and merged at the county level. For both 2021 and 2024 releases, Pearson’s correlation and student’s t-test were performed between uninsured rates and the age-standardized rates of the following at the county level: cancer prevalence, colorectal cancer screening, and mammography. Percentage and percentage-point changes in county age-standardized prevalence from the 2021 to 2024 reports were then calculated for the same variables, after which Pearson’s correlation was determined for relationships by rate of change.

Results:

The median uninsured rate among adults aged 18-64 decreased from 16.5% to 10.5% from 2019 to 2022. Negative correlations between uninsured rate and cancer measures remained steady or worsened as follows: The correlation between uninsured rate and self-reported cancer prevalence strengthened from borderline weakly negative in 2019 (R = 0.20, p < 0.001) to moderately negative in 2022 (R = 0.58, p < 0.001). The correlation between uninsured rate and colorectal cancer screening remained strongly negative (R = 0.64 in 2018-2019, R = 0.61 in 2022, p < 0.001 both years). The correlation between uninsurance and mammography strengthened from weakly negative (R = 0.28 in 2018-2019, p < 0.001) to borderline moderately negative (R = 0.40 in 2022, p < 0.001). There was a moderately positive correlation between percentage point change in uninsured status from 2019 to 2022 and change in self-reported cancer prevalence from 2019 to 2022 (R = 0.48, p < 0.001), but relationships with changes in colorectal cancer screening and mammography were negligible.

Conclusions:

The persistence of negative relationships between county uninsured rates and cancer screening measures indicates the need for further promotion of screening access in at-risk communities. The counterintuitive inverse relationship between uninsurance and self-reported cancer prevalence requires further assessment given the risk of underdiagnosis in counties with lower screening rates. These challenges are exacerbated by the 2023 expiry of pandemic-era emergency policies to promote health insurance access, necessitating ongoing inquiry as new data on uninsurance are released.

Disciplines

Community Health and Preventive Medicine | Medicine and Health Sciences

Comments

Our efforts have been supported by the Wayne State University School of Medicine Summer Research Fellowship

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