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Cancer screening utilization by residence and sexual orientation

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Abstract

Purpose

Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation.

Methods

Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors.

Results

Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24–0.73 and aOR = 0.79; 95% = 0.72–0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80–0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41–0.94) than heterosexuals, and there were no differences for breast screening.

Conclusion

We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.

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Authors and Affiliations

  1. Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA

    Minjee Lee, Wiley D. Jenkins & Eric Adjei Boakye

  2. Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA

    Minjee Lee & Eric Adjei Boakye

Authors
  1. Minjee Lee
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  2. Wiley D. Jenkins
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  3. Eric Adjei Boakye
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Contributions

ML developed the research question, performed the analysis, and drafted the manuscript. All authors interpreted the data, participated in the design and planning of the study, and edited the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Minjee Lee.

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This protocol was deemed exempt from Institutional Board Review at Southern Illinois University School of Medicine (Reference number 021203).

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Appendix

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See Tables

Table 4 Characteristics of US men by sexual orientation: behavioral risk factor surveillance system (BRFSS), 2014–2016
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Table 5 Characteristics of US women by sexual orientation: behavioral risk factor surveillance system (BRFSS), 2014–2016
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Table 6 Characteristics of US men by residence: behavioral risk factor surveillance system (BRFSS), 2014–2016
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Table 7 Characteristics of US Women by Residence: Behavioral Risk Factor Surveillance System (BRFSS), 2014–2016
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7.

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Lee, M., Jenkins, W.D. & Adjei Boakye, E. Cancer screening utilization by residence and sexual orientation. Cancer Causes Control 31, 951–964 (2020). https://doi.org/10.1007/s10552-020-01339-4

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  • DOI: https://doi.org/10.1007/s10552-020-01339-4

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