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Cancer Screening and Citizenship Status in the US
Jenny S Guadamuz1,2, Stacy Chen1, Gregory S Calip3
1Division of Health Policy and Management, School of Public Health, University of California, Berkeley.
JAMA Network Open
|August 10, 2026
Summary
Noncitizens experience lower cancer screening rates due to socioeconomic barriers and limited health care access. Improving access is crucial to reduce cancer mortality among this population.
Area of Science:
- Public Health
- Health Services Research
- Health Equity
Background:
- Noncitizens face significant health disparities, including poverty and inadequate healthcare access, contributing to adverse cancer outcomes.
- Cancer is a leading cause of death among noncitizens, yet little is known about how citizenship status impacts cancer screening rates.
Purpose of the Study:
- To examine cancer screening inequities related to citizenship status.
- To evaluate state-level variations in these inequities.
- To determine the mediating role of structural factors in these disparities.
Main Methods:
- Cross-sectional study utilizing nationally representative data from the National Health Interview Survey (2010-2023).
- Cancer screening eligibility determined by US Preventive Services Task Force guidelines.
- Mediation analysis using nonlinear multiple additive regression tree models to assess associations and mediators.
Main Results:
- Noncitizens exhibited significantly lower screening rates for colorectal, cervical, and breast cancer compared to US-born citizens.
- These disparities persisted throughout the study period and varied across states.
- Socioeconomic and healthcare factors jointly mediated these inequities, explaining a substantial proportion of the disparities.
Conclusions:
- Noncitizens have lower cancer screening rates, primarily driven by socioeconomic barriers and insufficient healthcare access.
- Interventions aimed at increasing cancer screening and reducing mortality among noncitizens must prioritize improving their healthcare access.
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