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Race- and ethnicity-based insurance coverage gaps for genetic testing for cancer in the greater Pittsburgh region

Director, Haley (2022) Race- and ethnicity-based insurance coverage gaps for genetic testing for cancer in the greater Pittsburgh region. Master Essay, University of Pittsburgh.

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Cancer has a large public health impact because it directly or indirectly affects all individuals, regardless of race and ethnicity. Hereditary breast and ovarian cancer (HBOC) and hereditary colorectal cancer (hCRC) often cluster in families and are implicated in 5-10% of breast cancers and 2-5% of colorectal cancers. Research has determined the variants in select genes that are likely to cause HBOC and hCRC, and individuals can receive genetic testing to determine if they are at an increased risk of developing these cancers. However, there are gaps in knowledge of and testing for these variants by race and ethnicity. There are also disparities in insurance coverage for individuals of different races and ethnicities. Identifying individuals with HBOC and hCRC is relevant to public health because cancer treatment is a burden on the healthcare system, and understanding risks of hereditary cancers can guide surveillance and management options. Laboratory billing claims data of individuals presenting at a UPMC facility between 2014-2019 was analyzed to determine whether there were gaps in genetic testing or inequities in insurance coverage for the genetic testing by race and ethnicity for HBOC and hCRC. The results showed that genetic testing for HBOC was more likely to be covered by an insurance company than hCRC, as 25.61% of HBOC tests were covered compared to 9.67% of hCRC tests. Furthermore, minoritized racial and ethnic groups were underrepresented in the study in comparison to census data in the region, composing only 6.31% of the study population, and overrepresented in Medicaid, with 27.5% of Black individuals and 6.67% of Asian individuals receiving coverage through Medicaid compared to 4.3% of white individuals. The results confirm that race- and ethnicity-based insurance coverage gaps exist for genetic testing for cancer, showing the importance of developing interventions to increase knowledge of and access to genetic testing for minoritized racial and ethnic groups.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Director, Haleyhrd14@pitt.eduhrd14
ContributionContributors NameEmailPitt UsernameORCID
Thesis advisorVento, Jodieventojm@pitt.eduventojmUNSPECIFIED
Committee MemberVitullo, Kathleenke.vitullo@gmail.comUNSPECIFIEDUNSPECIFIED
Committee MemberSabik, Lindsaylsabik@pitt.edulsabikUNSPECIFIED
Committee MemberFelter, Elizabethemfelter@pitt.eduemfelterUNSPECIFIED
Committee MemberDrake, Colemancdrake@pitt.educdrakeUNSPECIFIED
Date: 17 May 2022
Date Type: Completion
Submission Date: 11 April 2022
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 75
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Public Health Genetics
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: cancer, public health, health disparities, health equity, insurance coverage, genetic testing
Date Deposited: 17 May 2022 13:43
Last Modified: 17 May 2022 13:43


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