Table 3.
Summary of major findings by social determinants of health and type of cancer screening in U.S. studies on cancer prevention among people with HIV, 2010–2024
| Social determinant of health domains based on healthy people 2030 | |||||
|---|---|---|---|---|---|
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| Economic stability | Education access and quality | Healthcare access and quality | Neighborhood and built environment | Social and community context | |
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| Anal cancer screening | |||||
| Apaydin (2018) | Income level was not specifically discussed as a barrier to receiving HRA. However, participants discussed job flexibility and resources to address abnormal findings after HRA was cited as barriers to adherent follow-up. Resources included ability to schedule time away from work and transportation to HRA clinic | Educational level was not specifically discussed as a factor impacting HRA follow-up. However, knowledge and beliefs about HPV-related diseases or HRA was a topic of discussion. Beliefs of HRA were positive and thus a facilitator of follow-up. Participants reported that while HRA is painful and awkward, it is necessary. Fear of HRA results was a barrier to follow-up | Patient-provider communication was an important factor. Lack of provider knowledge and expertise to facilitate HRA follow-up is a barrier to care. Participants described facilitators including, positive provider skill and knowledge to offer anti-anxiety medication before the procedure. Strong provider communication skills and trust between the patient and provider were facilitators to follow-up Several participants described healthcare system inefficiencies, including barriers to using the scheduling system | Sexual behaviors were not specifically discussed as a barrier to HRA follow-up or relationship status Internalized stigma was a commonly cited barrier to HRA follow-up. Participants reported they avoided seeking support in their social circles as they felt embarrassed about having HPV infection Societal stigma was identified by almost all participants as a barrier to HRA follow-up. After disclosing their HPV anal disease to others, participants described difficulty gaining social support due to the stigma associated with the infection |
|
| Cachay (2018) | MSM HIV transmission risk factor was associated with a substantially increased rate from < HSIL to HSIL (HR: 3.30; 95% CI: 1.78–5.30) and HSIL regression (HR: 1.90; 95% CI: 1.07–2.90) | ||||
| Cachay (2023) | Overall prevalence of anal cytology was 49.8%. The prevalence among transgender participants was (46.9%), with no significant differences compared to cisgender adults. Prevalence was: 57.5% among MSM only, 52.4% among MSM who were injection drug users, and 33% among injection drug users. Compared to MSM only with no history of injection drug use, all other cisgender men had 45% lower odds of anal HSIL at initial screening | ||||
| Cruz (2023) | Annual income was not associated with self-reported anal pap uptake or HRA uptake | The prevalence of self-reported anal pap uptake was 42% among those with an educational attainment of high school or less and 59% with more than high school education (p = 0.018). Educational attainment was not associated with HRA uptake | Anal pap uptake or HRA uptake based on self-report did not differ by insurance type | The prevalence of anal pap uptake was 60% among heterosexuals, 32% among homosexual participants, and 53% among bisexual participants (p = 0.001). HRA uptake did not differ by sexual orientation Compared to men who have sex with women, men who have sex with men (aOR: 3.04; 95% CI: 1.79–5.19) and women (aOR: 3.00; 95% CI: 1.72–5.20) were more likely to self-report anal pap uptake. No associations were observed with HRA uptake |
|
| D'Souza (2013) | Prevalence of accepting anal pap testing was 90% among those with an income higher than $40,000 and 81%% among those with a lower income (p < 0.001). No significant associations were observed on multivariable analysis of gross income with declining anal pap testing | Prevalence of accepting pap testing was 88% among those with a college degree or higher and 78% among those with less than a college degree (p < 0.001). No significant association was observed between educational attainment with declining anal pap testing | |||
| Hernandez (2013) | Compared to those who did not complete college, those who completed college (aRR: 0.67; 95% CI: 0.48–0.93) and those who completed graduate school (aRR: 0.70; 95% CI: 0.49–1.00) had lower risk of HPV 16 infection | Compared to those without, those with a history of injection drug use had higher risk of prevalent HPV infection (aRR: 1.5; 95% CI: 1.1–1.9) | |||
| Hernandez (2024) | Annual income was not associated with biopsy-confirmed Anal HSIL | Compared to those with less than a graduate/professional degree, those with a graduate or professional degree had higher odds of biopsy confirmed anal HSIL (aOR: 2.63; 95% CI: 1.26–5.50) | Gender identity was not evaluated in multivariable models | ||
| Junkins (2024) | Prevalence of anal cancer screening was 63% among those living in the least socially vulnerable counties, 49% in low to moderate, 51% in moderate to high, and 60% in the most socially vulnerable counties. Social vulnerability was not evaluated in multivariable models | Prevalence of screening was 64% among homosexual participants, 8% among heterosexual participants, 66% among bisexual participants. Sexual identity was not associated with anal cancer screening uptake in multivariable models | |||
| Kutner (2024) | 69% of participants reported financial incentives would improve HRA retention by mitigating opportunity costs of a visit (e.g., taking time off from work) | 69% of patients reported that understanding anal cancer prevention facilitated their return for monitoring visits 62% of patients reported that more patient-facing educational materials about HRA would help them stay engaged with HRA | 46% of participants thought that after care pain management could be improved by consistently providing: transportation service when bleeding excessively, information about how to manage pain and products to alleviate symptoms Clinic social environment was reported as a barrier to HRA among 62% of patients, such as exposure to different medical assistants, the presence of sex discordant providers, too many people in the exam room, lack of privacy and discretion of front desk staff, losing familiar HRA providers that left the clinic. Patients were also deterred by social interactions in the clinic, such as providers laughing about a joke that the patient does not understand Provider communication skills were important with 69% said providers' confidence, use of a gentle demeanor and ability to ease patient anxiety with small talk as facilitators. Discussion of potential pain was a facilitator to high quality HRA. 54% reported communication about HRA can be a barrier to retention About half of patients reported scheduling as a barrier to HRA. And 38% reported clinic disorganization, strict late policy, limited insurance options and delays in after care assistance were barriers to HRA |
54% of patients recommended social support to motivate return visits 62% of patients reported internalized stigma or anticipated stigma alongside shame and embarrassment affected HRA retention | |
| Nyitray (2023) | Among those uninsured, 14% received DARE in the past year. Among those with insurance 14% also received DARE in the past year. Insurance status was not evaluated in multivariable analyses | Among men, 14% received DARE in the past year and 7% of transgender adults received DARE in the past year 15% of gay participants, 10% of bisexual participants received DARE in the past year. Sexual orientation was not associated with receiving DARE in the past year on multivariable analyses | |||
| Rim (2024) | Prevalence of receiving anal cytology in the past year was 5.1% among those employed, 3.7% among those unemployed or unable to work. There was no significant difference in prevalence between the two groups Prevalence of receiving anal cytology in the past year was 4.9% among those above the poverty level and 4.3% at or below the poverty level. There was no significant difference between the two groups | Prevalence of receiving anal cytology in the past 12 months was 2.4% among those with less than high school education, 3.5% with a high school degree or equivalent and 6% among those with more than a high school degree. Compared to those with more than a high school degree, the prevalence difference was lower among those with less than a high school degree (aPD: −3.6; 95% CI: −5.2 to −2.1) and high school degree or equivalent (aPD: −2.5; 95% CI: −3.9 to −1.1) | Prevalence of anal cytology was 5.4% among those with private insurance, 4.4% among those with public insurance only, 5.1% among those with Ryan White coverage, and 2.4% among the uninsured. There was no significant difference in prevalence by insurance type Among those who received anal cytology, 32% received care at a facility not known to provide HRA, 22% received at a facility with HRA on site, and 45% received care at a facility with known outside referral relationships | Prevalence of anal cytology was 9% in Western states, 1.4% in Midwestern states, 5.2% in Northeastern states, 3.0% in Southern states, and 9.7% in Puerto Rico. Compared to Western states, those in Southern states had a lower prevalence of anal cytology (aPD: −6.0; 95% CI: −10.5 to −1.6) |
Prevalence of anal cytology was 5% among gay, bisexual, and other MSM as well as transgender women over 35 years of age and other people with HIV aged 45 years or above; 7.7% among gay, bisexual, and other MSM as well as transgender women aged 35 years or above; 1.9% among other people with HIV aged 35 years or above, and 3.9% among those with HIV not in any high risk group. Compared to people with HIV not in a high risk group, gay, bisexual, other MSM, and transgender women aged 35 years or more had higher prevalence of anal cytology (aPD: 3.8; 95% CI: 1.1 to 6.5); and people with HIV aged 45 or above had a lower prevalence (aPD: −2.0; 95% CI: −3.3 to −0.7) Prevalence of anal cytology was 5.4% among cisgender males, 2.7% among cisgender females, and 6.6% among transgender women. Prevalence differences were not estimated for these groups |
| Schwartz (2013) | No significant associations were observed between educational attainment with AIN2 + positivity or any cytology outcome combination | ||||
| Wells (2018) | Health insurance type was not correlated with anal pap test or receiving anoscopy | Relationship status was not correlated with anal pap test or receiving anoscopy Identifying as a man who has sex with men was correlated with both receiving anal pap test (Pearson's r correlation =0.434; p = 0.00) and receiving anoscopy (Pearson's r correlation =0.300; p = 0.00). On multivariable analyses, compared to non-MSM, men who had sex men had higher odds of receiving anal pap testing (aOR: 3.70; 95% CI: 1.24–10.97) and anoscopy (aOR: 6.88; 95% CI:2.02–23.52) |
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| Wells (2022) | HRA prevalence within 6 months did not differ by monthly household income, housing status/stability, or employment status | HRA Prevalence within 6 months of abnormal anal cytology did not differ by educational attainment | HRA Prevalence within 6 months of an abnormal anal cytology did not differ by insurance type | HRA Prevalence within 6 months of an abnormal anal cytology did not differ by sexual orientation or relationship status HIV-related stigma score median did not differ by those who received HRA within six months or after six months of an abnormal anal cytology. On multivariable analyses, higher HIV/ AIDS related stigma score was associated with lower odds of follow-up within six months (aOR: 0.54; 95% CI: 0.33–0.90). Stigma was not associated with follow-up within 12 months Higher social support score was associated with higher odds of HRA follow up within six months (aOR: 1.03; 95% CI: 1.00–1.07). Social support was not associated with follow-up within 12 months |
|
| Ye (2021) | Prevalence of anal HSIL + was 3% among the unemployed, 5% among the disabled, 2.7% among the employed, 2.8% among the retired, and 6% among students | Prevalence of anal HSIL + among heterosexual adults was 0.7% and 4.3% among men who have sex with men. Prevalence of ever receiving anal pap was 62% among men who have sex with men, 8.4% among heterosexual men, and 1.5% heterosexual women Prevalence of anal HSIL + was 1.9% among those who were married with a life partner, 1.25% among those divorced/separated, 3.2% of single participants, and 1.6% among widowed participants Prevalence of anal HSIL + was 3.5% among men, 0.3% among women, and 0% among transgender individuals. Among men prevalence of ever receiving anal pap tests was 47%, 1.5% among women, and 87.5% among transgender adults |
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| Breast cancer screening | |||||
| Weinstein (2016) | The overall prevalence of adherence to mammography within 2 years was 50%. The prevalence was 64% among those who were employed or in school. Compared to their counterparts, those employed or in school had higher odds of adherence. (OR: 2.03; 95% CI: 1.10–3.77) | Among those with less than a high school education, prevalence of adherence to follow-up mammography within 2 years was 57%. Compared to their counterparts, those with less than a high school education had higher odds of adherence (aOR: 1.77; 95% CI: 1.06–2.95) | Among those who were foreign born the prevalence of follow-up was 62%. The prevalence was 63% among non-English speakers, 52% among single adults, and 51% among drug users. The odds of receiving follow-up mammography within 2 years of first screen was higher among those who were foreign born (aOR: 2.65; 95% CI: 1.52-4.64) and non-English speakers (OR: 1.96; 95% CI: 1.11–3.45) compared to their counterparts. Associations were not observed among those who were single or those with a history of drug use | ||
| Cervical cancer screening | |||||
| Baranoski (2011) | 77% of the unemployed or disabled, had no pap test done within 18 months of follow-up. Compared to the employed, the unemployed or disabled had higher odds of not receiving a pap test within 18 months (OR: 1.7; 95% CI: 1.3-.2.3). When stratified by nativity status, no association was observed among the non-US born but among US both the odds of not receiving a pap test within 18 months was higher among the unemployed (OR: 2.5; 95% CI: 1.4–4.7) 3% of those who received non-timely pap testing were enrolled in the Healthcare for the Homeless program,. No association was observed on multivariable analyses overall or by nativity status | About half of those with less than a high school education had no pap testing history within 18 months of follow-up. No association was observed on multivariable analyses or when stratified by nativity status | Among those who did not receive a pap test within 18 months, 24% lived within 2 miles of the hospital, 27.3% lived within 2 to < 5 miles, 18.0% lived within 5 to < 10 and 30.6% lived within ten miles away. No association was observed on multivariable analysis or when stratified by nativity status for most groups. Among those who were US born, those residing 5 to less than ten miles had higher odds of no pap testing within 18 months compared to those living within 2 miles of the hospital (OR: 2.0; 95% CI: 1.1–3.5) 80% of those who did not have timely pap had a ID trained provider but this provider characteristic was not associated with pap test receipt overall or by nativity status 31% of those who did not receive timely pap had over 75% of care visits with a male provider and this was associated with timely pap receipt (OR: 1.3; 95% CI: 1.0–1.7). This association was no longer observed after stratification by nativity status | 17% of those who did not receiving timely pap were non-English speakers. No association was observed in multivariable analyses overall and by nativity status 58% were US born women. Compared to non-US born women, US born women had higher odds of not receiving timely pap (aOR: 1.5; 95% CI: 1.0–2.3) 16.5% married women but was not associated with receipt of timely pap testing on multivariable analyses overall or by nativity status 45% of those who did not receive a timely pap had a history of drug use. And compared to those without a drug use history, those with a drug use history had higher odds of no pap testing within 18 months (aOR: 4.6; 95% CI: 2.2-9.9). This association was consistent among US born women (OR: 1.7; 95% CI: 1.2–2.5) and non-US born women (aOR: 5.8; 95% CI: 2.5–13.9) | |
| Baranoski (2012) | Among both those who received colposcopy within 6 months and those who did not, 79% were unemployed. On multivariable analyses, unemployment was not associated with decreased time to follow-up | 51% of those who received colposcopy within six months and 34% of those who did not were a high school graduate or higher (p = 0.04). Compared to those with less than a high school education, having a high school education or higher educational level was associated with decreased time to follow-up (aHR: 1.7; 95% CI: 1.2–2.6) | Among those who received colposcopy within six months, 33% were uninsured, 49% had Medicaid, 12% had Medicare and 7% had private insurance. Among those who did not receive colposcopy within 6 months, 29% were uninsured, 59% had Medicaid, 11% had Medicare and 1% had private insurance. Insurance status was not associated with time to follow-up 53% of those who received colposcopy within 6 months lived within 5 miles of the hospital, whereas among those who did not receive timely colposcopy 40% lived within that distance. No associations were observed on multivariable analyses Among those who received timely colposcopy, 33% received care at a gynecology clinic, 48% with an HIV nurse practitioner, and 19% other type of provider. Among those who did not receive timely colposcopy, 42% received care at gynecology clinic, 33% with an HIV NP, and 25% with another type of provider. Compared to those who received care at a gynecology clinic, receiving care with an HIV NP was associated with decreased time to colposcopy (aHR: 1.7; 95% CI:1.1–2.7) |
Among those who received timely colposcopy, 84% were an English speaker and among those who did not 77% were an English speaker. Primary English language speaker was not associated with time to follow-up Among those who received timely colposcopy, 41% were US born and among those who did not 45% were US born. Nativity status was not associated with time to follow-up 18% and 4% were married among those who did and did not receive timely colposcopy, respectively. Compared to those who were not married, being married was associated with decreased time to colposcopy (aHR: 3.5; 95% CI: 1.9–9.6) 24% and 33% reported illicit drug use among those who did and did not timely colposcopy within six months. Illicit drug use was not associated with time to colposcopy |
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| Barnes (2018) | The prevalence of being under screened was 59.7% among the uninsured or on county medical assistance, 58.6% among fed-state government insurance, 47.9% among those on Medicaid, 52.9% among those on Medicare, and 53.3% on commercial insurance. Compared to those who were uninsured or on county medical assistance, the odds of being under screened was significantly lower among Medicaid insured women (aOR: 0.63; 95% CI: 0.41–0.96). Insurance status was not associated with odds of abnormal cytology | ||||
| Bynum (2016) | Among those who received a pap test within less than a year, 25% were employed full time, 64% were unemployed. Among those who received two pap tests or more within first year of HIV diagnosis, 23% were employed full time, 67% were unemployed. Among those who received a pap test within less than a year, 59% had an income less than 10 k and 31% had an income of 10 k or more. Among those who received two pap tests or more within first year, 67% had an income of less than 10 k and 27% had an income of 10 k or more Employment status and Income were not associated with pap test receipt within less than a year, receiving two pap tests or more since HIV diagnosis, or with more frequent pap tests since HIV diagnosis |
Among those who received a pap test within less than a year, 20% had no high school degree, 33% had a high school degree, 46% had some college or above. Among those who received two pap tests or more within first year, 31% did not have a high school degree, 35% graduated high school of had a GED, 35% had some college or more. Compared to those with some college or above, those with a high school degree or equivalent were less likely to have at least two pap tests after their HIV diagnosis (aOR: 0.29; 95% CI: 0.10–0.84). No other associations were observed | Compared to those with high healthcare access (scale), those with low access had higher odds of receiving a pap test within the past year (aOR: 3.80; 95% CI: 1.34–10.78). No associations were observed with receipt of two paps within first year of HIV diagnosis or change in pap test frequency No associations were observed between ease of getting to medical appointments (hard/easy) with any pap test screening behavior outcome No associations were observed between having a personal healthcare provider with any screening behavioral outcome |
75% of participants who reported a pap within the past year and 80% of participants who reported two or more paps within their first year of HIV diagnosis were single. Compared to those who were married, those who were single were more likely to have two or more pap tests within first year of HIV diagnosis (aOR: 2.89; 95% CI: 1.07–7.81) Perceived HIV stigma and perceived discrimination were not associated with any cervical cancer screening behavioral outcome |
|
| Dailey-Garnes (2015) | Among those who were not screened for cervical cancer, 60% had less than four primary care visits in the year and 40% had four or more. Compared to those who had fewer than four primary care visits, those who had more than four had a higher prevalence of screening uptake (aPR: 1.21; 95% CI: 1.02–1.44) Among those who did not screen, 49% received care in a specialty care clinic setting and 45% at a family practice. Type of clinic was not associated with screening uptake | HIV risk factors were evaluated. Compared to those with heterosexual contact, no association was observed between injection drug use history with screening uptake | |||
| Fletcher (2014) | Participants reported knowledge that their HIV infection increased their risk of cervical cancer and higher awareness of cervical cancer as a preventable disease were facilitators of pap testing | Strong relationships with their provider was a facilitating factor to cervical cancer screening among women with HIV Transportation issues were a common barrier to attending cervical cancer screening, particularly for those with a longer commute to the clinic. Many relied on medical transportation assistance system Extensive wait times at the clinic were a barrier to screening Referral processes for gynecological care services were unclear. Several women thought that they needed a referral from their HIV care provider to receive screening |
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| Fletcher (2014) | Among those who worked full or part time, prevalence of pap smear non-adherence was 52%, 56% among those who do not work due to health, 29% among those unable to work, 52% among those not working for other reasons | Prevalence of non-adherence to pap smear receipt was 63% among those with less than a high school education, 44% among those with a high school degree or equivalent, and 48% among those with more than a high school degree | 62% of married participants were non-adherent to pap smears 65% of those with a history of injection drug use were non-adherent to pap smears 66% of those with a history of illicit drug use within the past 30 days were not adherent to pap smears Mean perceived stress score was 43.5 among those who were adherent to pap smear recommendations and 47.6 among those who were not Mean perceived discrimination score was 8.8 among those who were adherent to pap smears and 10.1 among those who were not Social support scale score mean was 35.6 among those who were adherent and 35.0% among those who were not adherent |
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| Frazier (2016) | Among those above poverty level, the prevalence of pap testing was 75.2% and among those at or below poverty level the prevalence was 80.1%. Compared to those at or below the poverty level, the prevalence of having a pap test in the last 12 months was 6% lower (aPR: 0.94; 95% CI: 0.90–0.99) The prevalence of homelessness was 8% among those who received a pap test within the past year | Educational attainment was not evaluated in multivariable analyses | Insurance status and patient-provider communication was not evaluated in multivariable analyses | Compared to those without a drug history, those with a history of any drug use had a 9% lower prevalence of pap testing within the past 12 months (aPR: 0.91; 95% CI: 0.83–1.00) No association was observed with nativity status | |
| Logan (2010) | Income was not associated with receipt of pap smears | Receipt of pap testing was associated with type of health insurance (p = 0.02). Patients who did not receive pap testing was more likely to be uninsured (64.7%) and receive care solely through Ryan White programs compared to other types like Medicaid or Medicare | HIV risk behavior was associated with receipt pap smear (p = 0.06) with injection drug users being more likely to have no pap smears History of incarceration was not associated with pap smear receipt |
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| Peprah (2018) | Compared to those with public health insurance, those who were uninsured or paid out of pocket were less likely to utilize pap testing over a ten year period (aHR: 0.87; 95% CI: 0.76–0.99). No other associations were observed by insurance type | Compared to those who did not have a history of drug use, those with an injection drug use history were less likely to receive pap testing over a ten year period (aHR: 0.80; 95% CI: 0.70–0.93) | |||
| Soto-Salgado (2024) | Women in Puerto Rico with HIV who received cervical Pap screening were around 39% more likely to have a household annual income below $20,000 compared to WLWH in the other 22 MMP jurisdictions who received cervical Pap screening (PR: 1.39, 95% CI: 1.29–1.49) | Of those who received cervical Pap screening, the prevalence of those in Puerto Rico with Medicaid or other public insurance was 76% higher than those in the other 22 U.S. MMP jurisdictions (PR: 1.76, 95% CI: 1.56–2.00) No significant associations were observed for those with a regular HIV provider | Women in Puerto Rico were more likely than those in the 22 other U.S. MMP jurisdictions to undergo cytology (aPR: 1.08; 95% CI: 1.03–1.13) | The percentage of those who reported higher than the median HIV stigma score or experiences with HIV health care discrimination did not differ between Puerto Rico and the other 22 MMP jurisdictions | |
| Tello (2010) | Employment status was not associated with missed gynecological appointments or a missed pap smear within the past year | Compared to those without a high school degree, women with a high school degree or equivalent (i.e., GED) were less likely to have no documented pap smear within the past year based on EHR data. (aOR: 0.3; 95% CI: 0.1–0.6) | Substance use was associated with higher odds of missing a gynecology appointment [aOR: 2.3 (95% CI: 1.0–5.3)] in the past year Caring for children and social support showed no associations with missing gynecological appointments or missed pap smears |
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| Colorectal cancer screening | |||||
| Burkholder (2015) | 21% of those without insurance, 35% of those with private insurance, and 29% of those with public insurance received CRC screening. No significant associations were observed by insurance status 35% of those with an external primary care provider received CRC. No significant association was observed | 23% of women, 27% of heterosexual men, and 33% of men who have sex with men received colorectal cancer screening. Compared to women, men who report to have sex with men were more likely to receive colorectal cancer screening (aHR: 2.03; 95% CI: 1.04–3.99) 15% of those with a history of substance use received CRC screening. No significant association was observed |
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| Kelly (2021) | Educational status was significantly associated with receipt of CRC screening (aOR: 0.69; 95% CI: 0.52–0.91), although comparison groups are unclear | Relationship status was not associated with receipt of CRC screening | |||
| Lam (2019) | Among both those with and without HIV, three or more outpatient visits was associated with higher likelihood of receiving CRC screening; PWH: aHR: 1.51; 95% CI: 1.23–1.86 and People without HIV: aHR: 1.54; 95% CI: 1.49–1.60. No association was observed when evaluating detection of adenoma or invasive colorectal cancer as the outcome | ||||
| Momplaisir (2012) | 52% of those with low SES were screened | 41% of those with Medicaid insurance and 51% with Other insurance were screened for CRC 51% of those who received care from a physician were screened for CRC and 36% of those who received care from a nurse practitioner or physician’s assistant Among those who received care with a clinic size of 50–300 patients during the observation period, 44% received CRC screening, compared to 48% of those at higher volume clinics with more than 300 patients 45% of those who received care at a Ryan White clinic received CRC screening |
17% of those with active substance use, 42% of those with a history of substance use, and 56% with no history received CRC screening | ||
| Lung cancer screening | |||||
| Islam (2023) | Compared to those on Medicare, those with Medicaid, charity care or other Government insurance were less likely to be adherent to lung cancer screening follow-up (aOR: 0.28; 95% CI: 0.09–0.89) No association was observed with increasing number of care visits during the observation period | No associations between LDCT adherence were observed with area-level poverty or rurality | |||
| Lopez (2022) | The prevalence of LDCT referral was 12% among those living at less than 100% of the federal poverty line, 12% among those 100–200% of the FPL, and 7% among those over 200% of the FPL. The prevalence of LDCT completion among those with a referral was 60%, 50%, and 33% respectively | 8% of those with private insurance, 9% of those with Medicare/Medicaid/VA insurance, and 0% of those with other insurance or uninsured received a LDCT referral. Among those with a referral, 36% of those with private insurance and 73% with Medicare/Medicaid/VA insurance completed screening The average number of care visits during the observation window was 12 among those with a referral and 9 among those without a referral and was 13 among those who completed screening and 11 among those who did not |
11% of those who identify as MSM received a referral and 63% completed screening. 11% of those with a history of illicit drug use received a referral and 30% completed screening. 0% of transgender participants received a referral | ||
| Triplette (2023) | Financial barriers and issues of cost were discussed by patients with HIV as a barrier to lung cancer screening. Income and employment status were not specifically discussed, | Educational level was not discussed. However, knowledge of LCS was low among PWH | Related to insurance, cost was discussed as a barrier. Also, healthcare provider recommendations and communication were facilitators to screening with 100% of patients stating they somewhat or strongly agree with the statement "If my provider recommended lung cancer screening, I would get it. " | ||
| Prostate cancer screening | |||||
| Leapman (2022) | Among those with HIV, compared to those living in the Northeast, the rates of PSA testing were higher in the South (aIRR: 1.18; 95% CI: 1.16–1.20). Among those without HIV, compared to those living in the Northeast, the rates of PSA testing were lower among those in the West (aIRR: 0.91; 95% CI: 0.90–0.92), and higher in the South (aIRR: 1.12; 95% CI: 1.11–1.13) |
A history of substance abuse was associated with lower rates of PSA testing among those with HIV (aIRR: 0.90; 95% CI: 0.89–0.91) and those without HIV (aIRR: 0.87; 95% CI: 0.86–0.88) |
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| Multiple cancer screening types | |||||
| Momplaisir (2014) | No significant associations were observed between annual income category with screening behaviors | No significant associations were observed between educational attainment and breast cancer screening behaviors Compared to those with a college education or above, those with a high school education or GED (aOR: 0.5; 95% CI: 0.3–0.8) and less than a high school education (aOR: 0.4; 95% CI: 0.2–0.6) were less likely to receive CRC screening | 58% of those who received care at an integrated care clinic and 51% of those at a nonintegrated care clinic received age-appropriate CRC screening 18% of those at an integrated clinic and 29% of those at a non-integrated care clinic received a mammogram in the last year; 29% and 51% respectively received a mammogram within the past 5 years Compared to those with zero yearly visits to their primary care provider, those with 1–3 (aOR: 3.3; 95% CI: 1.5–7.5) or > 3 (aOR: 4.7; 95% CI: 2.0–11.0) were more likely to get CRC screening. The same trends were observed among those who received breast cancer screenings within the past year and within the past 5 years | No associations with gender were observed Marital status was not associated with breast cancer screening behaviors. Compared to those who were married or living with a partner, those who were never married (aOR: 0.6; 95% CI: 0.3–0.8), divorced (aOR:0.5; 95% CI: 0.3–0.8) or other marital status (aOR: 0.5; 95% CI: 0.3–0.8) were less likely to get CRC screening |
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| Rahangdale (2010) | Of the pap smears conducted, 68 (45.9%) were performed by primary-care physicians, and 80 (54.1%) were performed by gynecologists | Primary language was not associated with pap smear uptake or receiving an abnormal pap result In the context of breast cancer screening, primary the language was important, with 100% of women who spoke primarily Spanish receiving mammograms, but only 58% of primarily English-speakers receiving mammogram |
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| Short (2019) | Living at or below the poverty level was not associated with receipt of pap smears or mammography within the past two years among those eligible Homelessness was associated with pap smear receipt. Compared to those who reported being homeless, those who did not have a higher prevalence of mammography receipt (aPR: 1.71; 95% CI: 1.21–2.41) | Educational attainment was not associated with receipt of pap smears or mammography within the past two years among those eligible | Insurance type was not associated with mammography receipt. Compared to those with public insurance only, those with any private insurance were less likely to receive a pap smear within the past 2 years (aPR: 0.81; 95% CI: 0.69–0.94). Living with Ryan White program coverage or being uninsured was not associated with pap smear receipt | ||
| Simonsen (2014) | Receipt of pap testing and mammography did not differ significantly by housing stability | Those with private insurance had lower prevalence of pap testing compared to all other insurance types (46% vs. 64%, p = 0.025). Mammography receipt did not differ by insurance type | Prevalence of pap testing and mammography did not differ significantly by immigration status or primary language | ||
Abbreviations: AIN anal intraepithelial neoplasia, aRR adjusted risk ratio, aIR adjusted incidence rate, aPD adjusted prevalence difference, aOR adjusted odds ratio, CI confidence intervals, CRC colorectal cancer, DARE digital anal rectal examination, EHR electronic health records, FPL: federal poverty level, GED General educational development, HMO Health management organization, HR hazards ratio, HRA high resolution anoscopy, HSIL high-grade intraepithelial lesions, HPV human papillomavirus, LDCT low-dose computed tomography, LCS Lung cancer screening, MMP Medical Monitoring Project, MSM men who have sex with men, MSW men who have sex with women, NP nurse provider, PR Puerto Rico, RWHAP Ryan White HIV/AIDS Program, PSA prostate-specific antigen, PCP primary care physician, PWH People with HIV