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Racial and Ethnic Changes in Preventive Cancer Screenings Among Low-Income Women Associated with Medicaid Expansion

Patterson, Anna (2021) Racial and Ethnic Changes in Preventive Cancer Screenings Among Low-Income Women Associated with Medicaid Expansion. Master Essay, University of Pittsburgh.

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Background: Racial and ethnic disparities in preventive cancer screenings among low-income women have been documented in previous literature. These disparities result in delayed cervical and breast cancer treatment, thus affecting survivability. The relationship between insurance status and use of preventive services is likely mediated by access to primary care. Medicaid expansions under the Affordable Care Act (ACA) were meant to help increase access to care and reduce disparities. Therefore, we examined changes in racial/ethnic disparities in pap smear and mammography use among low-income women pre- and post-Medicaid expansions.

Methods: An event-study (ES) design was used to analyze data from the Behavioral Risk Factor Surveillance System (BRFSS) from years 2012 – 2018 to estimate changes in the following outcomes: insurance status, having a usual source of care, and use of preventive cancer screenings. Trends were estimated separately for both Medicaid expansion and non-expansion states. Our study population included 216,484 women aged 18 – 64 years who had an income less than 138% of the Federal Poverty Level, and met eligibility criteria for screenings.

Results: In Medicaid expansion states, insurance coverage increased across all three groups, but Hispanic women remained less likely to have coverage compared to Non-Hispanic White (NHW) women. Additionally, disparities persisted in the probability of having a usual source of care between Hispanic and NHW women in expansion states. In both expansion and non-expansion states pap smear utilization decreased across all three groups from 2012 – 2018, with no notable reduction in racial/ethnic disparities. Further, in expansion states, mammography screenings remained higher among Non-Hispanic Black (NHB) women compared to NHW women, despite a decrease in screenings among NHB women.

Conclusion: State Medicaid expansions have increased insurance coverage but have not narrowed disparities in cancer screenings or the probability of having a usual source of care. Further research to understand the overall decrease in pap smear use is vital. These results suggest additional barriers exist aside from insurance coverage that affect using preventive cancer services. Therefore, additional social and health policies should be considered to remediate disparities in the use of preventive cancer care services.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Patterson, Annaanp192@pitt.eduanp192
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairRoberts, Ericeric.roberts@pitt.edueric.robertsUNSPECIFIED
Committee MemberTerry, Martha Annmaterry@pitt.edumaterryUNSPECIFIED
Date: 10 May 2021
Date Type: Completion
Submission Date: 12 April 2021
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 44
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Health Policy & Management
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: Health disparities, cancer screenings, medicaid expansion, Pap smear, mammogram, women's health
Date Deposited: 10 May 2021 22:12
Last Modified: 10 May 2021 22:12

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