MATERIAL HARDSHIP AND MULTI-CANCER SCREENING ADHERENCE: IMPLICATIONS BEYOND INSURANCE STATUS
Author(s)
Wafaa M. Bkheit, MD, Oluwagbemisola M. Agunbiade, MPH, Jillur Rahim, MA, Bisakha Sen, PhD.
The University of Alabama at Birmingham, Birmingham, AL, USA.
The University of Alabama at Birmingham, Birmingham, AL, USA.
Presentation Documents
OBJECTIVES: Material hardship creates barriers to screening beyond insurance coverage. This study examines the association between material hardship and multi-cancer screening adherence according to the U.S. Preventive Services Task Force (USPSTF) recommendations among women aged 45-64.
METHODS: We analyzed data from the 2022 and 2024 Behavioral Risk Factor Surveillance System (BRFSS) for women aged 45-64, excluding U.S. territories and 2023 data due to a smaller sample size. Multi-screening adherence was defined as completing all three: mammography within two years (USPSTF lowered the starting age in 2024), cervical cancer screening within guideline intervals (Pap test within 3 years or HPV/co‑testing within 5 years), and colorectal cancer screening according to test‑specific intervals (1-10 years). Material hardship scale included seven indicators (medical cost burden, employment loss, food insecurity, food stamps, inability to pay bills, utility shut-off, and unreliable transportation) categorized as 0, 1, or ≥2 hardships. We used a multivariable survey‑weighted linear probability model with state and year fixed effects, adjusting for income, health status, insurance, healthcare access, other sociodemographic characteristics and psychosocial distress.
RESULTS: The analytic sample comprised 10,915 respondents representing 1,412,228 women in the population. Overall, 23.8% were adherent to all three screenings while 12.6% completed none; 31.8% reported ≥1 hardship and 94.9% had health insurance. Material hardship was inversely associated with screening adherence. Compared with no hardship, one hardship corresponded to a 5‑percentage‑point decrease (p=0.02), and ≥2 hardships to a 7‑percentage‑point decrease (p=0.01). Compared with those earning <$25,000 annually, only women earning ≥$100,000 had higher adherence (p=0.01). Insurance status was not significantly associated with adherence (p=0.96). Sensitivity analysis restricted to insured women yielded similar results.
CONCLUSIONS: Material hardship was associated with significantly lower multi-cancer screening adherence, independent of income and insurance coverage. Multi-level interventions should integrate screening with social support systems and launch targeted interventions in low-income communities to address these barriers.
METHODS: We analyzed data from the 2022 and 2024 Behavioral Risk Factor Surveillance System (BRFSS) for women aged 45-64, excluding U.S. territories and 2023 data due to a smaller sample size. Multi-screening adherence was defined as completing all three: mammography within two years (USPSTF lowered the starting age in 2024), cervical cancer screening within guideline intervals (Pap test within 3 years or HPV/co‑testing within 5 years), and colorectal cancer screening according to test‑specific intervals (1-10 years). Material hardship scale included seven indicators (medical cost burden, employment loss, food insecurity, food stamps, inability to pay bills, utility shut-off, and unreliable transportation) categorized as 0, 1, or ≥2 hardships. We used a multivariable survey‑weighted linear probability model with state and year fixed effects, adjusting for income, health status, insurance, healthcare access, other sociodemographic characteristics and psychosocial distress.
RESULTS: The analytic sample comprised 10,915 respondents representing 1,412,228 women in the population. Overall, 23.8% were adherent to all three screenings while 12.6% completed none; 31.8% reported ≥1 hardship and 94.9% had health insurance. Material hardship was inversely associated with screening adherence. Compared with no hardship, one hardship corresponded to a 5‑percentage‑point decrease (p=0.02), and ≥2 hardships to a 7‑percentage‑point decrease (p=0.01). Compared with those earning <$25,000 annually, only women earning ≥$100,000 had higher adherence (p=0.01). Insurance status was not significantly associated with adherence (p=0.96). Sensitivity analysis restricted to insured women yielded similar results.
CONCLUSIONS: Material hardship was associated with significantly lower multi-cancer screening adherence, independent of income and insurance coverage. Multi-level interventions should integrate screening with social support systems and launch targeted interventions in low-income communities to address these barriers.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
P44
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
No Additional Disease & Conditions/Specialized Treatment Areas