Stimpson Jim P, Park Sungchul, Morenz Anna M, Gurley Tami, Wilson Fernando A
Department of Health Economics, Systems, and Policy, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Cancer Control. 2025 Jan-Dec;32:10732748251347731. doi: 10.1177/10732748251347731. Epub 2025 Jun 4.
IntroductionThis cross-sectional study examined the relationship between paid sick leave and colorectal cancer (CRC) endoscopy screening among employed adults, including the examination of potential pathways.MethodsWe analyzed data from 15,352 employed adults aged 45-75 from the 2021 and 2023 National Health Interview Survey. A generalized structural equation model (GSEM) assessed the direct and indirect pathways between employment status (full-time vs part-time), paid sick leave, health insurance, usual source of care, and CRC endoscopy screening. Survey weights were applied to ensure nationally representative estimates.ResultsFull-time employment was positively associated with paid sick leave (OR = 6.57, 95% CI: 5.85, 7.38) and health insurance (OR = 1.30, 95% CI: 1.07, 1.59). Paid sick leave increased the likelihood of having a usual source of care (OR = 1.57, 95% CI: 1.31, 1.87) and was directly associated with CRC screening (OR = 1.15, 95% CI: 1.03, 1.28). Health insurance increased the likelihood of having a usual source of care (OR = 5.32, 95% CI: 4.30, 6.58) and CRC screening (OR = 3.22, 95% CI: 2.58, 4.02). Usual source of care was also associated with CRC screening (OR = 3.53, 95% CI: 2.89, 4.32).ConclusionsPaid sick leave was associated with CRC endoscopy utilization both directly and indirectly through improved healthcare access. Workplace policies that expand paid sick leave, alongside efforts to strengthen insurance coverage and primary care access, may reduce barriers to CRC endoscopy screening and improve population health.
引言
本横断面研究调查了在职成年人的带薪病假与结直肠癌（CRC）内镜筛查之间的关系，包括对潜在途径的研究。
方法
我们分析了2021年和2023年全国健康访谈调查中15352名年龄在45 - 75岁的在职成年人的数据。一个广义结构方程模型（GSEM）评估了就业状况（全职与兼职）、带薪病假、医疗保险、通常的医疗服务来源和CRC内镜筛查之间的直接和间接途径。应用调查权重以确保全国代表性的估计。
结果
全职工作与带薪病假（OR = 6.57，95% CI：5.85，7.38）和医疗保险（OR = 1.30，95% CI：1.07，1.59）呈正相关。带薪病假增加了有通常医疗服务来源的可能性（OR = 1.57，95% CI：1.31，1.87），并与CRC筛查直接相关（OR = 1.15，95% CI：1.03，1.28）。医疗保险增加了有通常医疗服务来源的可能性（OR = 5.32，95% CI：4.30，6.58）和CRC筛查的可能性（OR = 3.22，95% CI：2.58，4.02）。通常的医疗服务来源也与CRC筛查相关（OR = 3.53，95% CI：2.89，4.32）。
结论
带薪病假通过改善医疗服务可及性，直接和间接地与CRC内镜检查的利用相关。扩大带薪病假的工作场所政策，以及加强保险覆盖和初级医疗服务可及性的努力，可能会减少CRC内镜筛查的障碍并改善人群健康。
