Incidence of and mortality from colorectal cancer (CRC) is higher for blacks than for whites, and for lower-income populations than for higher-income groups.1
Similar disparities are found in CRC screening.2
Health insurance coverage has been found to be an important strategy for reducing disparities in cancer screening. For example, National Health Interview Survey (NHIS) data from 1993 and 2005 demonstrated that only 38 percent of women with no health insurance were current with mammography, compared with 57 percent of women who had public forms of insurance.3
Similar patterns were found in the overall population, as well as in the subgroup of women who were most impoverished. There is similar evidence for CRC screening, with health insurance coverage and income accounting for differences in CRC screening rates among racial and ethnic groups.4
The complexity of addressing disparities is underscored by other research that finds persistent racial and ethnic disparities after accounting for these factors. However, in most of these studies, disparities are reduced, although not eliminated, compared to national levels.5
Additional research on the prevalence of CRC screening among lower-income, population-based samples, where health insurance is ubiquitous, may offer further insight into the complex relationship among income, insurance, race/ethnicity, and screening
This study documents the prevalence of CRC screening by endoscopic tests (flexible sigmoidoscopy or colonoscopy) or fecal occult blood testing (FOBT) in a large, sociodemographically diverse population that resides in low-income housing in Massachusetts. The endoscopic tests find both polyps and cancer through examining the colon directly; FOBT does not require an invasive procedure but has a lower accurate detection rate. Low-income housing residents represent an important population in which to examine CRC screening prevalence because, as a result of their income qualification for subsidized housing, they are largely qualified for the state Medicaid program or the state’s free care pool, both of which cover CRC screening. Further, because many subsidized housing residents are elderly, they have Medicare, which also covers CRC screening.
In this paper, we address two key questions: (1) what is the prevalence of CRC screening among insured low-income adults; and (2) do racial/ethnic differences exist in a low-income population that is insured?