The role of sick leave in increasing breast cancer screening among female employees in the U.S.

Aim: A major goal of the Affordable Care Act (ACA) is to expand access to preventive health services, but significant economic barriers remain. One such barrier is not having sick leave to utilize preventive medical care. This study uses nationally representative U.S. data to examine whether having sick leave is associated with increased breast cancer screening among female employees. Methods: 17,198 observations of female employees aged 40 and over were examined using the 2006-10 Medical Expenditure Panel Survey. We examined likelihood of having a clinical breast examination or mammography within 12 months with sick leave vs. no sick leave. Multivariate analyses adjust for age, education, race/ethnicity, poverty status, insurance, marital status, self-reported health and survey year. Afterward, we calculated predicted probabilities from the multivariate logistic regression to measure the impact of sick leave on breast cancer screening. Results: 71.8% of female employees with sick leave have clinical breast exam versus 60.1% of females with no sick leave. For mammograms, these percentages are 63.2% and 52.0%, respectively. After adjusting for socioeconomic status, access to care and health status, sick leave increases the odds of clinical breast exam (OR. = 1.22; p<. .001) and mammogram (OR. = 1.25; p<. .001). Conclusions: The United States has the fewest days of sick leave on average of any industrialized nation. However, more local governments are mandating employers to provide sick leave. Our results suggest that these policies are likely to significantly increase the odds of clinical breast examination and mammography among female workers.