Publication Date

2013-06-27

Availability

Open access

Embargo Period

2013-06-27

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Epidemiology (Medicine)

Date of Defense

2013-02-18

First Committee Member

Kristopher L. Arheart

Second Committee Member

Lora E. Fleming

Third Committee Member

David J. Lee

Fourth Committee Member

Hosanna Soler-Vilá

Fifth Committee Member

Sharon L. Christ

Abstract

Cancer is the second leading cause of mortality in the United States, affecting more than 13 million individuals it has impacted the lives of a significant proportion of the population. With improvements in detection and treatment there have been more early diagnoses and improved prognosis for many survivors. These positive changes have led to an increase in the number of survivors that continue to work through diagnosis and treatment and or return to work. There are an estimated 7.5 million working survivors in the US, though their proportions vary by occupational sectors. With occupational differences in workplace accommodations and perceived disparities in the motivation for re-entering the workforce, this dissertation examined health disparities among cancer survivors in the US workforce. Focusing on the under-explored associations among this special US worker population, we investigated disparities in health behaviors pertinent to health post diagnosis, such as cancer screening; and examined differences in indicators of health ( such as; functional limitation, psychological distress, number of days in bed and reported health status). Most importantly differences were stratified by occupation and health insurance which are the main factors reinforcing health behaviors and return to work among survivors. Using data from the 1997-2010 National Health Interview Survey (NHIS), we found that approximately 91.0% of working survivors reported having health insurance. This is higher than the 86.0% of insured persons without a history of cancer. We also found that while a large proportion of persons without a history of cancer reported having private insurance (71.1%) compared to working survivors (62.6%), adjustments for increased age associated with diagnosis decreased the difference between both working groups. Health insurance appears to partially mediate the relationship between cancer status and employment, as such, understanding the distribution of the type of insurance available to workers within occupational sectors is important to wellness-programs targeting this special group of workers. The Patient Protection and Affordable Care Act (H.R. 3590), passed by the 111th US Congress under President Barack Obama in December 2009 has shown promise of being beneficial to cancer survivors. With exclusions for preexisting conditions such as cancer and insurance rates based accordingly, this bill will allow working cancer survivors to secure health insurance in new jobs that are more amenable to their physical and mental capabilities post diagnosis. With a multitude of studies on working survivors concentrated on European populations, this dissertation sought to fill a research gap in exploring the existing health disparities among working cancer survivors within the US. Recognizing the diverse population of working survivors in the US and cognizant of the health disparities that exist among occupational sectors the findings from this research can further inform public policy aimed at the this worker population.

Keywords

Cancer screening; Survivors; Occupation; Health disparities; Mammogram; Colorectal

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