Table 2.

Health insurance coverage disruptions and cancer screening^a

Reference	Sample size, No.	Setting, data source, and year	Insurance coverage measures	Outcome measures	Key findings
Ayanian et al., 2000 (27)	223 128 adults aged 18-64 y	National; BRFSS, 1997-1998	Self-reported short-term uninsured (uninsured <1 y) with coverage gap <1 year vs currently insured (private and/or public)	Self-reported Pap test ≤3 y, mammography ≤2 y, fecal occult blood test ≤2 y, and sigmoidoscopy ≤5 y among eligible adults	4.3 % short-term uninsured Compared with currently insured, short-term uninsured were less likely to receive mammography (78.7% vs 89.0%, P < .05) or Pap test (89.5% vs 93.7%, P < .05) No differences observed for receipt of CRC screenings
Bednarek and Schone, 2003 (28)	11 755 women aged 21-64 y	National; MEPS, 1996	Self-reported duration of private or public coverage, measured as 1-6 mo, 7-11 mo vs all 12 mo	Self-reported use of mammography and Pap test ≤2 y among eligible women	Percentage short-term insured 1-6 and 7-11 mo not reported Compared with continuously insured for 12 mo, insured for 1-6 mo less likely to have Pap smears (79.9% vs 70.7%, P < .05) or mammograms (66.7% vs 53.6%, P < .05) Compared with insured 7-12 mo, insured 1-6 mo were less likely to have Pap smears (81.8% vs 70.7%, P < .05) or mammograms (67.0% vs 53.6%, P < .05). Continuously insured and insured 7-12 mo did not statistically significant differ
Broyles et al., 2002 (29)	1512 women aged ≥18 y	Oklahoma’s BRFSS, 1993	Self-reported temporarily uninsured with coverage gap previous year vs continuously insured	Self-reported use of mammography (in the past 2 y) and Pap test screening (in the past 3 y) among eligible women	Percentage temporarily uninsured in previous year not reported Use of mammograms and Pap smears similar in temporarily uninsured and continuously insured (OR = 0.8 and OR = 0.9, respectively; both P > .05)
Freund et al., 2019 (30)	333 adults aged 40-74 y	Minority race/ethnicity or low SES participants recruited across 4 sites in 3 states: Chinese Americans in Boston, MA; Hispanic in Columbus, OH; Appalachian populations in OH’s Appalachian region; and African American and Black populations in Philadelphia, PA. Patients recruited from community-based organizations, faith-based organizations, public housing, screening events, health fairs, and from existing research studies. Years of data collection not stated	Self-reported insurance instability in past 12 mo defined as uninsured, losing coverage, or changing insurance vs stable insurance status (insured, uninsured)	Self-reported use of screening and date of last test. Up to date for BC, cervical cancer, or CRC screening status calculated per USPSTF	32.8% reported insurance instability No statistically significant differences in BC (72.6% vs 80.6%, P = .23), cervical cancer (67.2% vs 73.4%, P = .48), and CRC (61.4% vs 70.1%, P = .19) screening between adults with insurance coverage instability compared with those with stable coverage
Jerant et al., 2013 (31)	92 809 adults aged ≥18 y	National; MEPS, 2000-2008; 2-y panels	Self-reported insurance loss during 2-y follow-up period vs no private and/or public coverage change (continuously insured and continuously uninsured)	Self-reported use of CRC screening (fecal occult blood testing ≤2 y and/or endoscopy ≤5 y), Pap test ≤3 y, and mammography ≤2 y among eligible adults	3193 adults lost insurance. Those with insurance loss less likely to receive Pap (OR = 0.6, 95% CI = 0.5 to 0.8) and mammography (OR = 0.6, 95% CI = 0.4 to 0.8) than those without insurance change. Also less likely to receive CRC screenings, but association not statistically significant (OR = 0.7, 95% CI = 0.4 to 1.0)
Koroukian, 2004 (32)	140 592 women aged 40-64 y	Ohio Medicaid claims and enrollment files, 1992-1999	Duration of coverage = length of enrollment in Medicaid (≤12, 13-24, 25-36 mo, etc [up to 8 y])	Receipt of annual and regular annual screening mammography from claims	40.7% enrolled ≤12 mo, 17.6% enrolled 13-24 mo, 41.7% enrolled >24 mo Proportion of women receiving screening mammography increased statistically significantly each additional year of Medicaid enrollment (AOR = 1.6, 95% CI = 1.6 to 1.6) Mean annual mammograms increased from 0.08 in women with enrollment ≤12 mo to 0.26 in women with enrollment ≥7 y
McWilliams et al., 2003 (37)	2036 adults aged 60-64 y in 1996; No. of women not stated	National; Health and Retirement Study, 1994, 1996	Self-reported coverage gap measured as intermittently insured (insured in either 1994 or 1996) vs privately and/or publicly insured in both 1994 and 1996 (continuously insured)	Self-reported mammography ≤2 y	216 were intermittently insured Compared with continuously insured, intermittently insured less likely to receive mammography (76.0% vs 57.7%, P < .05)
O’Leary et al., 2019 (38)	10 831 adults who turned 50 y during 2010-2013	Oregon Medicaid claims data, 2010-2014	New enrollment in Medicaid at 50 y vs prior enrollment before 50 y	CRC screening with colonoscopy, sigmoidoscopy, or stool testing from claims within 12 mo of age 50 y	Percentage newly enrolled not reported No differences in CRC screening newly enrolled in Medicaid and prior enrollment (RR = 1.0, 95% CI = 0.8 to 1.3, P = .87)
Staras et al., 2010 (39)	237 015 girls aged 9-17 y	Florida Medicaid enrollment and claims, June 2006 to Dec 2008	Coverage duration measured as no. of months enrolled in Medicaid (1–31)	At least 1 HPV vaccine claim	Percentages by duration of months enrolled in Medicaid not reported Longer length of Medicaid enrollment positively associated with receipt of at least 1 HPV vaccination. HPV vaccination rates were 3.5%, 12.8%, 19.0%, 22.2%, 28.4% for girls enrolled in Medicaid for 1-7, 8-13, 14-19, 20-25, 26-31 mo, respectively

^aAOR = adjusted odds ratio; BC = breast cancer; BRFSS = Behavioral Risk Factor Surveillance Survey; CI = confidence interval; CRC = colorectal cancer; MEPS = Medical Expenditure Panel Survey; OR = odds ratio; RR = risk ratio; SES = socioeconomic status; USPSTF = United States Preventive Services Task Force.