Breast and Cervical Cancer Screening: Impact of Health Insurance Status, Ethnicity, and Nativity of Latinas

Abstract

PURPOSE Although rates of cancer screening for Latinas are lower than for nonLatina whites, little is known about how insurance status, ethnicity, and nativity interact to infl uence these disparities. Using a large statewide database, our study examined the relationship between breast and cervical cancer screening rates and socioeconomic and health insurance status among foreign-born Latinas, US-born Latinas, and non-Latina whites in California.METHODS Data from the1998 California Women's Health Survey (CWHS) were analyzed (n = 3,340) using multiple logistic regression models. Utilization rates of mammography, clinical breast examinations, and Papanicolaou (Pap) smear screening among foreign-born Latinas, US-born Latinas, and non-Latina whites were the outcome measures.RESULTS Foreign-born Latinas had the highest rates of never receiving mammography, clinical breast examinations, and Pap smears (21%, 24%, 9%, respectively) compared with US-born Latinas (12%, 11%, 7%, respectively) and non-Latina whites (9%, 5%, 2%, respectively). After controlling for socioeconomic factors, foreign-born Latinas were more likely to report mammography use in the previous 2 years and Pap smear in the previous 3 years than non-Latina whites. Lack of health insurance coverage was the strongest independent predictor of low utilization rates for mammography (odds ratio [OR] = 2.05; 95% confi dence interval [CI], 1.53-2.76), clinical breast examinations (OR = 2.29; 95% CI, 1.80-2.90) and Pap smears (OR = 2.89; 95% CI, 2.17-3.85.) CONCLUSIONS Breast and cervical cancer screening rates vary by ethnicity and nativity, with foreign-born Latinas experiencing the highest rates of never being screened. After accounting for socioeconomic factors, differences by ethnicity and nativity are reversed or eliminated. Lack of health insurance coverage remains the strongest predictor of cancer screening underutilization.

Mammography use among older women of seven Latin American and Caribbean Cities

“…The lower likelihoods of mammography use among older women with public sources of health insurance and no having insurance (Buenos Aires, Bridgetown, Sao Paulo, Santiago, and Mexico City), compared with private sources of health insurance, are consistent with other reports (Hsia et al, 2000;Coughlin et al, 2003;Selvin and Brett, 2003;Rodríguez et al, 2005). Lack of insurance or public insurance, which are markers of poverty, might limit access to preventive care and ability to afford a mammogram (e.g., due to its high cost) in these cities.…”

“…A great heterogeneity also exists among Latinas in the US (Garbers and Chiasson, 2004). Foreignborn Latinas have higher mammography rates than US whites but have no differences from US-born Latinas after adjusting for socioeconomic factors (Rodríguez et al, 2005;Valdez et al, 2001); Mexican American women have lower mammography rates than Puerto Rican and Cuban American women (Suarez et al, 2000), and Mexican women have lower mammography rates than Mexican American women (Zambrana et al, 1999).…”

Undocumented immigrants and their use of medical services in Orange County, California

“…However, what part undocumented immigrants, who only account for about 20% of the nation's uninsured population, play in this problem is not entirely clear (Okie, 2007). Undocumented immigrants who do not have the means to gain access to medical care, which is available by paying in cash or with public or private medical insurance, often find the door closed to most health care (Rodriguez, Ward, & Perez-Stable, 2005).…”

A National Study of Out-of-Pocket Expenditures for Mammography Screening

“…9 An important barrier to receiving a mammogram is the woman's or the family's absolute out-of-pocket expenditure for the service. 6,10 Underuse of mammography screening because of burdensome out-of-pocket expenditures may be most common among women who are of low income, 6,8,[11][12][13] are uninsured, 6,7,[12][13][14] are insured through health plans with increased cost sharing, [15][16][17][18][19] or overestimate their copayment. 6,10 In fact, both the perceived and actual out-of-pocket expenditures have been demonstrated to be the most important aspect of cost that acts as a barrier to receiving a mammogram.…”