The Influence of Social Determinants on Cancer Screening in a Medicaid Sample

Authors

Anne R. Markus, Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia. Electronic address: armarkus@gwu.edu.
Yixuan Li, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
Marceé E. Wilder, The Department of Emergency Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.
Jillian Catalanotti, The Department of Emergency Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.
Melissa L. McCarthy, Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.

Document Type

Journal Article

Publication Date

3-10-2023

Journal

American journal of preventive medicine

DOI

10.1016/j.amepre.2023.02.005

Abstract

INTRODUCTION: Little attention has been paid to the influence of individually measured social determinants of health on cancer screening tests in the Medicaid population. METHODS: Analysis was conducted on 2015-2020 claims data from a subgroup of Medicaid enrollees from the District of Columbia Medicaid Cohort Study (N=8,943) who were eligible for colorectal (n=2,131), breast (n=1,156), and cervical cancer (n= 5,068) screening. Participants were grouped into 4 distinct social determinants of health groups on the basis of their responses to social determinants of health questionnaire. This study estimated the influence of the 4 social determinants of health groups on the receipt of each screening test using log-binomial regression adjusted for demographics, illness severity, and neighborhood-level deprivation. RESULTS: The receipt of cancer screening tests was 42%, 58%, and 66% for colorectal, cervical, and breast cancer, respectively. Those in the most disadvantaged social determinants of health group were less likely to receive a colonoscopy/sigmoidoscopy than those in the least disadvantaged one (adjusted RR=0.70, 95% CI=0.54, 0.92). The pattern for mammograms and Pap smears was similar (adjusted RR=0.94, 95% CI=0.80, 1.11 and adjusted RR=0.90, 95% CI=0.81, 1.00, respectively). In contrast, participants in the most disadvantaged social determinants of health group were more likely to receive fecal occult blood test than those in the least disadvantaged one (adjusted RR=1.52, 95% CI=1.09, 2.12). CONCLUSIONS: Severe social determinants of health measured at the individual level are associated with lower cancer preventive screening. A targeted approach that addresses the social and economic adversities that affect cancer screening could result in higher preventive screening rates in this Medicaid population.

APA Citation

Markus, Anne R.; Li, Yixuan; Wilder, Marceé E.; Catalanotti, Jillian; and McCarthy, Melissa L., "The Influence of Social Determinants on Cancer Screening in a Medicaid Sample" (2023). GW Authored Works. Paper 2599.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2599

Department

Health Policy and Management