Pathways to cancer screening: The role of citizenship

Under the Patient Protection and Affordable Care Act (PPACA), all foreign-born who are “lawfully present” in the United States will be eligible for healthcare coverage beginning January 1, 2014. Currently, pathways to citizenship include naturalization after 5 years of legal permanent residency, which has also been identified as a threshold for deteriorating health among immigrants. The objective of this study is to examine the association between citizenship, duration in the U.S., and cancer screening over time. We analyzed 11 years (2000-2010) of consolidated data from the Medical Expenditure Panel Survey linked with the National Health Interview Survey. Multivariate analyses were conducted, revealing that over time, compared to foreign-born citizens living in the U.S. for 5 years or more, foreign-born non-citizens living in the U.S. less than 5 years had lower odds of receiving a mammogram (N=70,585) or clinical breast exam (N=70,394) in the past 2 years {OR(95% CI) = .52(.41-.66); .53(.41-.67)}, as did U.S.-born citizens {.80(.71-.89); .85(.76-.95)}. Foreign born non-citizens living in the U.S. fewer than 5 years had lower odds of being screened for colorectal cancer (N=80,024) in the past 5 years and cervical cancer (N=109,467) in the past 3 years {.43(.32-.59); .54(.31-.95)}, as did foreign born non-citizens living in the U.S. at least 5 years {.75(.67-.85); .50(.41-.60)}. Evidence supporting a protective effect for citizenship with 5+ years of U.S. residency should be considered for best practices in immigration policy recommendations for who is considered “lawfully present” in the U.S. and eligible for a timely pathway to preventive healthcare.