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Health Insurance–Related Disparities in Colorectal Cancer Screening in Virginia

¹ School of Public Health and ² Division of General Internal Medicine, University of North Carolina, Chapel Hill, North Carolina

Requests for reprints: Vanessa de Bosset, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, CB#7435, 2106-B McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435. Phone: 919-259-2476; Fax: 919-966-2089. E-mail: vanessad{at}email.unc.edu

Background: Colorectal cancer (CRC) screening rates remain low in the United States. The effect of health insurance on CRC screening is not clear. We assessed the association between having health insurance and being screened for CRC and the factors that modify this association.

Methods: We used data from the 2005 Virginia Behavioral Risk Factor Surveillance System to evaluate the association of self-reported insurance coverage on self-reported CRC screening among all men and women ages 50 years (N = 2,887). Prevalence odds ratios (POR) were estimated using unconditional logistic regression. All covariates were assessed for potential effect measure modification and confounding. All analyses accounted for the Behavioral Risk Factor Surveillance System complex survey sampling design.

Results: Overall, participants who reported having insurance coverage were more than twice as likely to report being screened for CRC compared with those who reported having none [crude POR, 2.16; 95% confidence interval (95% CI), 1.26-3.68]. This relationship differed between men and women (POR_males, 3.37; 95% CI, 1.63-6.96; POR_females, 1.46; 95% CI, 0.74-2.89). After adjusting for age and income, self-reported insurance coverage had a positive association with report of being screened among men (POR, 2.02; 95% CI, 0.96-4.23) but not among women (POR, 0.81; 95% CI, 0.34-1.93).

Conclusions: Men who reported having health insurance were more likely to report having CRC screening than those who reported not having insurance coverage. However, this effect was not observed in women. These findings, if confirmed in other study populations, indicate that improving CRC screening coverage may require not only insurance status specifications but also gender-explicit considerations. (Cancer Epidemiol Biomarkers Prev 2008;17(4):834–7)