ABSTRACT
Introduction: During the COVID-19 pandemic, the unemployment rate has sharply risen from 3.5% in February2020 to 13.3% in May 2020, a level not seen since the Great Depression. There are an estimated 21.0 millionunemployed adults in the United States. Employers are the most common source of health insurance amongworking-aged adults and their families. Thus, job loss may lead to loss of insurance and reduce access to cancerscreening, which can detect cancer at earlier, more treatable stages, and reduce cancer mortality. In this study, weexamined sequential associations between unemployment, health insurance, and cancer screening to informCOVID's potential longer-lasting impacts on early cancer detection. Methods: Up-to-date (UTD) and recent (past-year) breast (BC) and colorectal cancer (CRC) screening prevalence were computed among respondents aged 50-64 years in 2000-2018 National Health Interview Survey data.Respondents were grouped as unemployed (not working but looking BC n=852;CRC n=1,747) and employed(currently working BC n=19,013;CRC n= 36,566). A series of logistic regression models with predicted marginalprobabilities were used to estimate unemployed vs. employed unadjusted (PR) and adjusted prevalence ratios(aPR) and corresponding 95% Confidence Intervals (CI). Results: Unemployed adults were four times as likely to be uninsured as employed adults (41.4% v 10.0%, p-value<0.001). Unemployment was associated with lower UTD breast (67.8% vs 77.5%, p-value<0.001, PR=0.82, 95%CI0.77,0.87) and colorectal (49.4% and 60.1%, p-value<0.001, PR=0.86, 95%CI 0.80, 0.92) cancer screeningprevalence. These differences remained after adjusting for race/ethnicity, age, and sex, but were eliminated afteraccounting for health insurance. Patterns and magnitudes of PR and aPRs were similar for past-year CRC and BCscreening prevalence. Conclusion: Unemployment was adversely associated with guideline-recommended and potentially life-savingbreast and colorectal cancer screening. Compared to the employed, the unemployed disproportionately lackedhealth insurance, which accounted for their lower cancer screening utilization. Expanding and ensuring healthinsurance coverage after job loss may mitigate COVID-19's economic impacts on cancer screening.