Mansur Arian, Zhang Fang, Lu Christine Y
Harvard Medical School, Boston, MA 02115, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA.
J Pers Med. 2022 Jul 15;12(7):1146. doi: 10.3390/jpm12071146.
Genetic testing is increasingly used in clinical practice to assist with the diagnosis of genetic diseases and/or provide information about disease risk, and genetic counseling supports patient understanding of test results before and/or after genetic testing. Therefore, access to genetic testing and counseling is important for patient care. Health insurance coverage is a major determinant of access to health care in the United States. Uninsured individuals are less likely to have a regular source of health care than their insured counterparts. Different health insurance types and benefits also influence access to health care. Data on the association of health insurance and uptake of genetic testing and/or counseling for cancer risk are limited. Using data from the National Health Interview Survey, we examined the uptake of genetic testing and/or counseling for colorectal cancer (CRC) risk by health insurance type. We found that only a small proportion of individuals undergo genetic testing and/or counseling for CRC risk (0.8%), even among subgroups of individuals at risk due to family or personal history (3.7%). Insured individuals were more likely to undergo genetic testing and/or counseling for CRC risk, particularly those with Military and Private insurance plans, after adjusting for various demographic, socioeconomic, and health risk covariates. Further investigations are warranted to examine potential disparities in access and health inequities.
基因检测在临床实践中的应用日益广泛，用于辅助诊断遗传疾病和/或提供疾病风险信息，而遗传咨询则有助于患者在基因检测前后理解检测结果。因此，获得基因检测和咨询服务对患者护理至关重要。在美国，医疗保险覆盖范围是获得医疗保健服务的主要决定因素。未参保个体比参保个体更不可能有固定的医疗保健来源。不同类型的医疗保险及其福利也会影响获得医疗保健服务的机会。关于医疗保险与癌症风险基因检测和/或咨询服务使用情况之间关联的数据有限。我们利用美国国家健康访谈调查的数据，按医疗保险类型研究了结直肠癌（CRC）风险基因检测和/或咨询服务的使用情况。我们发现，即使在因家族或个人病史而处于风险中的亚组人群中（3.7%），也只有一小部分个体接受了结直肠癌风险基因检测和/或咨询服务（0.8%）。在对各种人口统计学、社会经济和健康风险协变量进行调整后，参保个体更有可能接受结直肠癌风险基因检测和/或咨询服务，尤其是那些拥有军事保险和私人保险计划的个体。有必要进一步开展调查，以研究在获得服务方面的潜在差异和健康不平等问题。
