US women screen at low rates for both cervical and colorectal cancers than a single cancer: a cross-sectional population-based observational study
Figures
![](https://iiif.elifesciences.org/lax/76070%2Felife-76070-fig1-v1.tif/full/617,/0/default.jpg)
Graphical abstract.
Screening rates differ by calculation approach. A patient-centered approach considers the total number of screens each woman has, whereas a population-centered system documents each single test completion. Our data show much lower women-centered cervical cancer and colorectal cancer (CRC) screening rates than a population-based screening approach. This difference is especially relevant as women may be able to do these two cancer screenings at home by themselves.
Tables
Demographic characteristics of the study population.
Weighted % | Eligible for analysis (n = 40,511) | |
---|---|---|
Age, n (%) | ||
50–54 | 35.8 | 12,165 (30.0) |
55–59 | 31.3 | 13,757 (34.0) |
60–64 | 32.9 | 14,589 (36.0) |
Race, n (%) | ||
NH White | 67.4 | 31,340 (77.4) |
NH Black | 10.6 | 3401 (98.4) |
NH Other/Multiracial | 6.9 | 2484 (6.1) |
Hispanic | 13.5 | 2836 (7.0) |
Unknown/Refused | 1.5 | 450 (1.1) |
Marital, n (%) | ||
Married/partnered | 63.4 | 25,022 (61.8) |
Unmarried* | 35.9 | 15,335 (37.9) |
Unknown/refused | 0.7 | 154 (0.4) |
Education, n (%) | ||
Less than high school | 11.6 | 2293 (5.7) |
High school | 25.1 | 9447 (23.3) |
Attended college/Tech school | 31.1 | 11,066 (27.3) |
Graduated college/Tech school | 32.1 | 17,671 (43.6) |
Refused/don’t know | 0.2 | 34 (0.1) |
Location, n (%) | ||
Urban | 92.7 | 33,500 (82.7) |
Rural | 6.2 | 6292 (15.5) |
Unknown/missing | 1.1 | 719 (1.8) |
Income, n (%) | ||
<50,000 | 36.5 | 14,870 (36.7) |
50,000+ | 46.4 | 20,295 (50.1) |
Don’t know/refused | 17.1 | 5346 (13.2) |
Employment status†, n (%) | ||
Employed/self-employed | 59.5 | 25,289 (62.4) |
Unemployed, looking | 5.4 | 1866 (4.6) |
Unemployed, not looking | 21.3 | 8392 (20.7) |
Unable to work | 12.7 | 4763 (11.8) |
Refused | 1.2 | 201 (0.5) |
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*
Unmarried includes divorced, widowed, separated, and never married.
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†
‘Unemployed, not looking’ includes ‘Homemaker, Student, and Retired’, ‘Unemployed, looking’ includes out of work over a year and out of work less than a year.
Up-to-date screening status by woman by screening modality.
Dual screened, n = 24,678; 58.2% (57.1, 59.4) | Current for colorectal only, n = 22225.4% (4.9, 5.9) | |||
---|---|---|---|---|
Pap only, within last 3 years | HPV only, within last 5 years | Pap and HPV, within last 5 years | ||
Blood stool only, last year | 5.0 (4.3, 5.8) | 0.1 (0.001, 0.2) | 3.0 (2.5, 3.6) | 10.0 (7.7, 13.1) |
Sigmoidoscopy only, last 5 years | 0.6 (0.4, 0.8) | <0.1% | 0.4 (0.3, 0.5) | 1.2 (0.6, 2.3) |
Colonoscopy only, last 10 years | 54.6 (53.2, 55.9) | 1.9 (1.4, 2.5) | 27.2 (26.0, 28.3) | 83.3 (79.4, 86.6) |
Two CRC tests | 3.8 (3.4, 4.3) | <0.1% | 3.3 (2.8, 4.0) | 5.5 (3.4, 8.6) |
Current for cervical cancer only, n = 10,051 27.1% (26.0, 28.2) | 66.5 (64.2, 68.6) | 2.9 (2.2, 3.7) | 30.7 (28.6, 32.8) | 100% |
Not current for either, n = 3560; 9.3% (8.7, 9.9) |
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Women receiving only one of the two screens
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CRC: The left-hand column lists the types of colorectal cancer screening that a woman could report. The far right-hand column presents the weighted screening proportions (95% CI) of women with only CRC screening by that modality. For instance, 10.0% of the 5.4% of women who were only current for CRC indicated they had been screened with a blood stool test within the last year but had no other CRC screen and no other cervical cancer screen. Likewise, 83.3% of the 5.4% of women who were only current on CRC screening (but had no other CRC screen and no other cervical cancer screen) indicated that they had a colonoscopy within the past 10 years.
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Cervical: The second to bottom row indicates the weighted screening proportions (95% CI) of women who only were up- to -date with cervical cancer screening by the columnar headings for types of cervical cancer screening modalities. For instance, 66.5% of the 27.1% of women who only had cervical cancer screening received a Pap test within the past 3 years. Likewise, 30.7% of the 27.1% of women who only had cervical cancer screening had received co-testing within the past 5 years.
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Women who had both screens by modality
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The top row indicates that 58.2% of all women were up-to-date with both cervical cancer and colorectal cancer screening (dual-screening). The inner 12 cells indicate the weighted percentage of women with dual-screening by modality. For instance, 54.6% of the 58.2% of women having both screens up-to-date did so with a colonoscopy and a Pap test. Likewise, 27.4% of 58.7% of women having both screens up-to-date did so with colonoscopy and cotesting.
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Women not up-to-date with either screen
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The bottom row indicates that 9.3% of the analytic cohort received neither screen because of underscreening or no screening.
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CI, confidence interval; CRC, colorectal cancer.
Sociodemographic descriptors by screening category.
Total | Dual-screening | Cervical cancer screening alone | CRC screening alone | Neither screening | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n = 40,511 | N = 24,678 | N = 10,051 | N = 2222 | N = 3560 | ||||||||
N | Unweighted row % | Weighted row % | N | Unweighted row % | Weighted row % | N | Unweighted row % | Weighted row % | N | Unweighted row % | Weighted row % | |
Age, (n, row %) | ||||||||||||
50–54 | 6121 | 50.3 | 47.4 | 4603 | 37.8 | 40.0 | 355 | 2.9 | 3.1 | 1086 | 8.9 | 9.5 |
55–59 | 8864 | 64.4 | 62.5 | 2893 | 21.0 | 22.7 | 778 | 5.7 | 5.2 | 1222 | 8.9 | 9.6 |
60–64 | 9693 | 66.4 | 66.0 | 2555 | 17.5 | 17.3 | 1089 | 7.5 | 7.9 | 1252 | 8.6 | 8.8 |
Race (n, row %) | ||||||||||||
White | 19,507 | 62.2 | 60.3 | 7345 | 23.4 | 24.8 | 1799 | 5.7 | 5.6 | 2689 | 8.6 | 9.3 |
Black | 2198 | 64.6 | 60.7 | 856 | 25.2 | 26.6 | 137 | 4.0 | 5.4 | 210 | 6.2 | 7.4 |
Other* | 1335 | 53.7 | 59.2 | 706 | 28.4 | 25.2 | 135 | 5.4 | 3.0 | 308 | 12.4 | 12.6 |
Hispanic | 1381 | 48.7 | 46.5 | 1025 | 36.1 | 39.4 | 126 | 4.4 | 5.2 | 304 | 10.7 | 8.8 |
Education (n, row %) | ||||||||||||
Less than high school graduate | 965 | 42.1 | 41.0 | 775 | 33.8 | 36.8 | 152 | 6.6 | 6.9 | 401 | 17.5 | 15.3 |
High school graduate | 5109 | 54.1 | 52.9 | 2574 | 27.3 | 27.7 | 583 | 6.2 | 6.5 | 1181 | 12.5 | 12.8 |
Attended college/Tech school | 6587 | 59.5 | 60.0 | 2820 | 25.5 | 26.2 | 679 | 6.1 | 5.4 | 989 | 8.9 | 8.4 |
Graduated college/Tech school | 11,994 | 67.9 | 67.0 | 3876 | 21.9 | 24.2 | 816 | 4.6 | 3.8 | 985 | 5.6 | 5.1 |
Income (n, row %) | ||||||||||||
<$50K | 7779 | 52.3 | 49.7 | 4127 | 27.8 | 29.8 | 1021 | 6.9 | 6.7 | 1943 | 13.1 | 13.8 |
≥$50K | 13,711 | 67.6 | 65.7 | 4562 | 22.5 | 24.5 | 930 | 4.6 | 4.3 | 1092 | 5.4 | 5.5 |
Marital status (n, row %) | ||||||||||||
Married or partnered | 15,966 | 63.8 | 61.0 | 6014 | 24.0 | 26.3 | 1230 | 4.9 | 5.0 | 1812 | 7.2 | 7.7 |
Single* | 8630 | 56.3 | 53.7 | 3995 | 26.1 | 28.2 | 979 | 6.4 | 6.0 | 1731 | 11.3 | 12.1 |
Occupational status (n, row %) | ||||||||||||
Employed | 15,613 | 61.7 | 58.6 | 6566 | 26.0 | 28.6 | 1126 | 4.5 | 4.4 | 1984 | 7.9 | 8.4 |
Unemployed, looking† | 975 | 52.3 | 52.3 | 533 | 28.6 | 28.8 | 111 | 60 | 5.6 | 247 | 13.2 | 13.4 |
Unemployed, not looking† | 5327 | 63.5 | 62.5 | 1758 | 21.0 | 23.3 | 543 | 6.5 | 5.8 | 764 | 9.1 | 9.0 |
Unable to work | 2662 | 55.9 | 53.5 | 1132 | 23.8 | 25.6 | 435 | 9.1 | 9.2 | 534 | 11.2 | 11.7 |
Location (n, row %) | ||||||||||||
Urban | 20,903 | 62.4 | 58.9 | 8105 | 24.2 | 26.8 | 1762 | 5.3 | 5.3 | 2730 | 8.2 | 9.0 |
Rural | 3479 | 55.3 | 52.0 | 1662 | 26.4 | 28.4 | 431 | 6.9 | 7.2 | 720 | 11.4 | 12.4 |
Chronic conditions (n, row %) | ||||||||||||
ANY | 16,168 | 63.2 | 60.7 | 5724 | 22.4 | 24.5 | 1631 | 6.4 | 6.4 | 2052 | 8.0 | 8.4 |
Cardiac | 1117 | 56.5 | 55.1 | 457 | 23.1 | 23.5 | 176 | 8.9 | 8.4 | 228 | 11.5 | 13.1 |
Stroke | 745 | 58.6 | 60.6 | 293 | 23.1 | 24.2 | 101 | 8.0 | 5.2 | 132 | 10.4 | 9.9 |
Lung | 4039 | 60.2 | 58.5 | 1539 | 22.9 | 25.6 | 479 | 7.1 | 6.3 | 655 | 9.8 | 9.6 |
Arthritis | 9799 | 64.3 | 62.9 | 3237 | 21.3 | 22.3 | 1049 | 6.9 | 7.2 | 1148 | 7.5 | 7.6 |
Kidney | 751 | 62.3 | 63.2 | 242 | 20.1 | 19.5 | 96 | 8.0 | 5.2 | 117 | 9.7 | 12.1 |
Diabetes | 2988 | 58.6 | 54.8 | 1233 | 24.2 | 28.9 | 413 | 8.1 | 7.6 | 468 | 9.2 | 8.7 |
Depression | 5987 | 62.2 | 60.2 | 2133 | 22.2 | 24.5 | 695 | 7.2 | 6.7 | 805 | 8.4 | 8.5 |
Skin cancer | 2182 | 70.4 | 68.4 | 540 | 17.4 | 18.7 | 189 | 6.1 | 5.1 | 190 | 6.1 | 7.8 |
Other cancer | 2282 | 69.3 | 67.2 | 648 | 19.7 | 22.8 | 209 | 6.3 | 6.3 | 156 | 4.7 | 3.7 |
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CRC, colorectal cancer.
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*
Single includes divorced, widowed, separated, and never married.
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†
‘Unemployed, not looking’ includes ‘Homemaker, Student, and Retired’, ‘Unemployed, looking’ includes out of work over a year and out of work less than a year.
Multinomial multivariate regression.
N = 42,701Weighted n = 19,849,774 | Referent outcome: neither screen | Referent outcome: dual screens | Referent outcome:cervical only | |||
---|---|---|---|---|---|---|
Dual screen | Cervical only | CRC only | Cervical only | CRC only | CRC only | |
aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
Age | ||||||
50–54 | Ref | Ref | Ref | Ref | Ref | Ref |
55–59 | 1.35 (1.09, 1.67) | 0.60 (0.48, 0.76) | 1.76 (1.25, 2.47) | 0.44 (0.39, 0.51) | 1.30 (0.98, 1.74) | 2.93 (2.17, 3.96) |
60–64 | 1.46 (1.18, 1.79) | 0.45 (0.36, 0.56) | 2.55 (1.81, 3.58) | 0.31 (0.27, 0.36) | 1.75 (1.30, 2.35) | 5.63 (4.14, 7.66) |
Race | ||||||
White | Ref | Ref | Ref | Ref | Ref | Ref |
Black | 2.25 (1.62, 3.13) | 1.73 (1.22, 2.44) | 1.58 (0.95, 2.61) | 0.77 (0.64, 0.92) | 0.70 (0.46, 1.07) | 0.91 (0.59, 1.41) |
Other* | 0.72 (0.46, 1.12) | 0.76 (0.47, 1.21) | 0.37 (0.21, 0.64) | 1.05 (0.74, 1.50) | 0.51 (0.33, 0.80) | 0.49 (0.30, 0.80) |
Hispanic | 1.68 (1.25, 2.25) | 2.34 (1.72, 3.18) | 1.42 (0.77, 2.63) | 1.39 (1.10, 1.77) | 0.84 (0.48, 1.50) | 0.61 (0.34, 1.10) |
Education | ||||||
Less than high school | Ref | Ref | Ref | Ref | Ref | Ref |
High school graduate | 1.37 (1.02, 1.83) | 1.08 (0.80, 1.46) | 1.14 (0.65, 1.98) | 0.78 (0.61, 1.01) | 0.83 (0.49, 1.39) | 1.06 (0.62, 1.80) |
Attended college/Tech school | 1.98 (1.46, 2.69) | 1.47 (1.07, 2.00) | 1.30 (0.76, 2.22) | 0.74 (0.58, 0.95) | 0.65 (0.40, 1.07) | 0.88 (0.53, 1.46) |
Graduated college/Tech school | 3.35 (2.33, 4.81) | 2.02 (1.39, 2.94) | 1.66 (0.94, 2.93) | 0.60 (0.46, 0.79) | 0.50 (0.31, 0.81) | 0.82 (0.49, 1.36) |
Income | ||||||
<$50K | Ref | Ref | Ref | Ref | Ref | Ref |
≥$50K | 3.32 (2.64, 4.18) | 2.19 (1.71, 2.80) | 2.13 (1.54, 2.96) | 0.66 (0.58, 0.75) | 0.64 (0.49, 0.84) | 0.98 (0.74, 1.29) |
Chronic conditions† | ||||||
Arthritis | 1.83 (1.54, 2.18) | 1.28 (1.06, 1.55) | 2.17 (1.65, 2.87) | 0.70 (0.61, 0.80) | 1.19 (0.94, 1.50) | 1.70 (1.31, 2.19) |
Diabetes | 1.34 (1.06, 1.69) | 1.34 (1.03, 1.75) | 1.79 (1.25, 2.55) | 1.00 (0.83, 1.22) | 1.33 (0.98, 1.81) | 1.33 (0.95, 1.86) |
Depression | 1.35 (1.11, 1.63) | 1.05 (0.85, 1.29) | 1.47 (1.09, 1.99) | 0.78 (0.68, 0.89) | 1.09 (0.85, 1.41) | 1.41 (1.07, 1.84) |
Skin cancer | 1.04 (0.73, 1.48) | 0.78 (0.53, 1.15) | 0.75 (0.48, 1.17) | 0.75 (0.61, 0.92) | 0.72 (0.54, 0.97) | 0.97 (0.69, 1.36) |
Other cancer | 2.90 (2.09, 4.05) | 2.28 (1.57, 3.31) | 3.08 (1.94, 4.91) | 0.78 (0.62, 0.99) | 1.06 (0.75, 1.51) | 1.35 (0.90, 2.03) |
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aOR, adjusted odds ratio; CI, confidence interval; CRC, colorectal cancer. Bold values = statistically significant.
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*
Other means American Indian, Native Hawaiian, Asian, Multiracial, and 'Other'.
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†
Persons may have more than one condition or cancer.
Unadjusted multinomial regression.
Referent outcome: neither screen | Referent outcome: dual screens | Referent outcome:cervical only | ||||
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Dual screens | Cervical only | CRC only | Cervical only | CRC only | CRC only | |
OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
Age | ||||||
50–54 | Ref | Ref | Ref | Ref | Ref | Ref |
55–59 | 1.29 (1.07, 1.56) | 0.55 (0.45,0.68) | 1.68 (1.24, 2.29) | 0.43 (0.37, 0.49) | 1.30 (1.01, 1.69) | 3.05 (2.31, 4.01) |
60–64 | 1.48 (1.24, 1.78) | 0.45 (0.37, 0.56) | 2.74 (2.04, 3.70) | 0.31 (0.27, 0.35) | 1.85 (1.44, 2.39) | 6.04 (4.60, 7.93) |
Race | ||||||
White | Ref | Ref | Ref | Ref | Ref | Ref |
Black | 1.28 (0.98, 1.67) | 1.33 (1.01, 1.76) | 1.20 (0.77, 1.86) | 1.04 (0.88, 1.22) | 0.93 (0.64, 1.36) | 0.90 (0.61, 1.33) |
Other* | 0.73 (0.49, 1.09) | 0.76 (0.49, 1.17) | 0.35 (0.21, 0.60) | 1.04 (0.77, 1.40) | 0.49 (0.32,0.74) | 0.47 (0.29, 0.74) |
Hispanic | 0.80 (0.64, 1.00) | 1.63 (1.25, 2.12) | 0.96 (0.62, 1.51) | 2.04 (1.67, 2.50) | 1.21 (0.80,1.83) | 0.59 (0.38, 0.91) |
Education | ||||||
Less than high school | Ref | Ref | Ref | Ref | Ref | Ref |
High school graduate | 1.54 (1.20, 1.98) | 0.90 (0.67, 1.21) | 1.14 (0.76, 1.72) | 0.58 (0.46, 0.75) | 0.74 (0.51, 1.08) | 1.27 (0.84, 1.91) |
Attended college/Tech school | 2.62 (2.03, 3.37) | 1.29 (0.96, 1.74) | 1.42 (0.96, 2.11) | 0.49 (0.39, 0.63) | 0.54 (0.38, 0.78) | 1.10 (0.75, 1.62) |
Graduated college/Tech school | 4.84 (3.67, 6.38) | 1.96 (1.43, 2.69) | 1.64 (1.09, 2.45) | 0.41 (0.32, 0.52) | 0.34 (0.24, 0.48) | 0.83 (0.57, 1.22) |
Income | ||||||
<$50K | Ref | Ref | Ref | Ref | Ref | Ref |
>$50K | 3.30 (2.79, 3.90) | 2.07 (1.72, 2.48) | 1.60 (1.24, 2.07) | 0.63 (0.56, 0.70) | 0.49 (0.39, 0.60) | 0.78 (0.62, 0.97) |
Marital status | ||||||
Married or partnered | Ref | Ref | Ref | Ref | Ref | Ref |
Single† | 0.56 (0.48, 0.66) | 0.68 (0.57,0.81) | 0.78 (0.61, 0.99) | 1.21 (1.08, 1.35) | 1.38 (1.13,1.69) | 1.14 (0.92, 1.42) |
Occupational status | ||||||
Employed | Ref | Ref | Ref | Ref | Ref | Ref |
Unemployed, looking‡ | 0.56 (0.41, 0.78) | 0.64 (0.46, 0.88) | 0.81 (0.51, 1.28) | 1.12 (0.87, 1.45) | 1.43 (0.95, 2.17) | 1.27 (0.83, 1.94) |
Unemployed, not looking‡ | 0.99 (0.83, 1.19) | 0.76 (0.60, 0.96) | 1.22 (0.92, 1.63) | 0.76 (0.64, 0.91) | 1.23 (0.97, 1.57) | 1.61 (1.22, 2.13) |
Unable to work | 0.64 (0.52,0.79) | 0.64 (0.50, 0.81) | 1.52 (1.10, 2.10) | 0.99 (0.84, 1.16) | 2.36 (1.81, 3.08) | 2.39 (1.78, 3.20) |
Location | ||||||
Urban | Ref | Ref | Ref | Ref | Ref | Ref |
Rural | 0.64 (0.52, 0.78) | 0.76 (0.61, 0.95) | 0.97 (0.72, 1.30) | 1.20 (1.04, 1.39) | 1.52 (1.20, 1.94) | 1.27 (0.98, 1.65) |
Chronic conditions§ | ||||||
Cardiac | 0.64 (0.48, 0.87) | 0.59 (0.42,0.83) | 1.11 (0.74, 1.65) | 0.92 (0.74, 1.14) | 1.72 (1.26, 2.35) | 1.87 (1.33, 2.64) |
Stroke | 0.96 (0.64, 1.42) | 0.80 (0.52, 1.23) | 0.90 (0.54, 1.51) | 0.84 (0.64, 1.10) | 0.94 (0.63, 1.39) | 1.12 (0.73, 1.72) |
Lung | 0.95 (0.80, 1.14) | 0.89 (0.70, 1.13) | 1.15 (0.87, 1.53) | 0.93 (0.77, 1.12) | 1.21 (0.95, 1.54) | 1.30 (0.97, 1.74) |
Arthritis | 1.51 (1.30, 1.76) | 0.99 (0.83, 1.18) | 2.27 (1.80, 2.86) | 0.65 (0.58, 0.74) | 1.50 (1.24, 1.81) | 2.29 (1.85, 2.82) |
Kidney | 0.84 (0.57, 1.23) | 0.56 (0.36, 0.87) | 0.76 (0.44, 1.30) | 0.66 (0.49, 0.91) | 0.90 (0.59, 1.39) | 1.36 (0.83, 2.23) |
Diabetes | 1.04 (0.83, 1.29) | 1.18 (0.89, 1.58) | 1.72 (1.24, 2.38) | 1.66 (1.27, 2.15) | 1.66 (1.27, 2.15) | 1.46 (1.05, 2.01) |
Depression | 1.16 (0.99, 1.37) | 0.97 (0.79, 1.20) | 1.56 (1.21, 2.01) | 0.84 (0.72, 0.98) | 1.34 (1.08, 1.65) | 1.60 (1.25, 2.05) |
Skin cancer | 1.41 (1.01, 1.95) | 0.80 (0.56, 1.14) | 1.11 (0.73, 1.67) | 0.57 (0.48, 0.68) | 0.79 (0.60, 1.04) | 1.38 (1.01, 1.88) |
Other cancer | 3.03 (2.26, 4.06) | 2.16 (1.54, 3.03) | 3.14 (2.07, 4.77) | 0.71 (0.58, 0.88) | 1.04 (0.75, 1.43) | 1.45 (1.01, 2.09) |
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Significant results are shown in bold italic font.
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*
Other means American Indian, Native Hawaiian, Asian, Multiracial and ‘Other’.
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†
Single includes divorced, widowed, separated, and never married.
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‡
‘Unemployed, not looking’ includes ‘Homemaker, Student, and Retired’, ‘Unemployed, looking’ includes out of work over a year and out of work less than a year.
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§
Persons may have more than one condition or cancer.