Background: We sought to examine the lack of paid sick leave among working cancer survivors by sociodemographic/socioeconomic and employment characteristics and its association with preventive services use in the United States. Methods: Working cancer survivors (ages 18–64 years; n=7,995; weighted n=3.43 million) were identified using 2001–2018 National Health Interview Survey data. Adjusted prevalence of lack of paid sick leave by sociodemographic and socioeconomic characteristics, as well as job sector, working hours, and employer size, were generated using multivariable logistic regression models. Separate analyses examined the associations of lack of paid sick leave with use of various preventive services. Results: Of all working cancer survivors, 36.4% lacked paid sick leave (n=2,925; weighted n=1.25 million), especially those working in food/agriculture/construction/personal services occupations or industries (ranging from 54.9% to 88.5%). In adjusted analyses, working cancer survivors with lower household income (<200% of the federal poverty level, 48.7%), without a high school degree (43.3%), without health insurance coverage (70.6%), and who were self-employed (89.5%), were part-time workers (68.2%), or worked in small businesses (<50 employees, 48.8%) were most likely to lack paid sick leave. Lack of paid sick leave was associated with lower use of influenza vaccine (ages 18–39 years, 21.3% vs 33.3%; ages 40–49 years, 25.8% vs 38.3%; ages 50–64 years, 46.3% vs 52.4%; P<.001 for all), cholesterol screening (ages 18–39 years, 43.1% vs 62.5%; P<.05), and blood pressure check (ages 18–39 years, 43.1% vs 62.5%; P<.05) compared with survivors having paid sick leave. Conclusions: In the United States, more than one-third of all working cancer survivors and more than half of survivors working for small employers and in certain occupations/industries lack paid sick leave. Survivors with lower household income or educational attainment are particularly vulnerable. Moreover, lack of paid sick leave is associated with lower use of some recommended preventive services, suggesting that ensuring working cancer survivors have access to paid sick leave may be an important mechanism for reducing health disparities.
Submitted December 2, 2021; final revision received July 28, 2022; accepted for publication July 29, 2022.
Author contributions:Study concept and design: All authors. Statistical analysis: Zheng. Interpretation of results: All authors. Manuscript preparation: Zheng. Manuscript revision: All authors.
Disclosures: Z. Zheng, X. Han, and J. Zhao have disclosed receiving grant/research support from AstraZeneca, outside the scope of this study. Dr. Yabroff has disclosed serving as a member of the Flatiron Health Equity Advisory Board. All authors from the American Cancer Society (ACS) are employed by the ACS, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector for research. W. Song has disclosed not receiving any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Correspondence: Zhiyuan Zheng, PhD, Surveillance and Health Equity Science, American Cancer Society, 250 Williams Street, Atlanta, GA 30303. Email: firstname.lastname@example.org
GreidanusMA, de BoerAG, de RijkAE, et al.Perceived employer- related barriers and facilitators for work participation of cancer survivors: a systematic review of employers’ and survivors’ perspectives. Psychooncology2018;27:725–733.
GreidanusMA, de BoerAG, de RijkAE, Perceived employer- related barriers and facilitators for work participation of cancer survivors: a systematic review of employers’ and survivors’ perspectives. Psychooncology 2018;27:725–733.10.1002/pon.451428753741)| false
MillerS. High-value care, workplace flexibility aid employees with cancer. Accessed September 9, 2021. Available at:https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/high-value-care-and-workplace-flexibility-aid-employees-with-cancer.aspx)| false
de MoorJS, KentEE, McNeelTS, Employment outcomes among cancer survivors in the United States: implications for cancer care delivery. J Natl Cancer Inst 2021;113:641–644.3253383910.1093/jnci/djaa084)| false
PeipinsLA, SomanA, BerkowitzZ, et al.The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey. BMC Public Health2012;12:520.
PeipinsLA, SomanA, BerkowitzZ, The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey. BMC Public Health 2012;12:520.2278838710.1186/1471-2458-12-520)| false
US Bureau of Labor Statistics. The economics daily: 94 percent of managers, 56 percent of construction and extraction workers had paid sick leave, 2019. Accessed April 20, 2022. Available at:https://www.bls.gov/opub/ted/2020/94-percent-of-managers-56-percent-of-construction-and-extraction-workers-had-paid-sick-leave.htm)| false
US Bureau of Labor Statistics. Employee benefits survey: paid sick leave: what is available to workers?Accessed September 9, 2021. Available at:https://www.bls.gov/ncs/ebs/factsheet/paid-sick-leave.htm#ref1)| false
RamseySD, BloughD, KirchhoffA, Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 2013;32:1143–1152.10.1377/hlthaff.2012.1263)| false
ZhengZ, JemalA, Tucker-SeeleyR, Worry about daily financial needs and food insecurity among cancer survivors in the United States. J Natl Compr Canc Netw 2020;18:315–327.3213550910.6004/jnccn.2019.7359)| false
Centers for Disease Control and Prevention, National Center for Health Statistics. NHIS data, questionnaires and related documentation. Accessed April 20, 2020. Available at:https://www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm12921382)| false
HanX, ZhaoJ, ZhengZ, Medical financial hardship intensity and financial sacrifice associated with cancer in the United States. Cancer Epidemiol Biomarkers Prev 2020;29:308–317.10.1158/1055-9965.EPI-19-046031941708)| false
HeymannJ, SpragueA. Why adopting a national paid sick leave law is critical to health and to reducing racial and socioeconomic disparities—long past due. JAMA Health Forum 2021;2:e210514.10.1001/jamahealthforum.2021.051436218669)| false
DeRigneLA, Stoddard-DareP, QuinnL. Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. Health Aff 2016;35:520–527.10.1377/hlthaff.2015.0965)| false
American Cancer Society. Why people with cancer are more likely to get infections. Accessed September 12, 2021. Available at:https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/why-people-with-cancer-are-at-risk.html)| false
JiangC, YabroffKR, DengL, Prevalence of underlying medical conditions associated with severe COVID-19 illness in adult cancer survivors in the United States. J Natl Cancer Inst 2022;114:156–159.10.1093/jnci/djab01233533404)| false
US Department of Labor, Wage and Hour Division. Families First Coronavirus Response Act: employer paid leave requirements. Accessed September 12, 2021. Available at:https://www.dol.gov/agencies/whd/pandemic/ffcra-employer-paid-leave)| false
The White House. FACT SHEET: President Biden to call on all employers to provide paid time off for employees to get vaccinated after meeting goal of 200 million shots in the first 100 days. Accessed September 27, 2021. Available at:https://www.whitehouse.gov/briefing-room/statements-releases/2021/04/21/)| false
Internal Revenue Service. COVID-19-related tax credits for paid leave provided by small and midsize businesses FAQs. Accessed October 4, 2021. Available at:https://www.irs.gov/newsroom/covid-19-related-tax-credits-for-paid-leave-provided-by-small-and-midsize-businesses-faqs)| false
KoH, GliedSA. Associations between a New York City paid sick leave mandate and health care utilization among Medicaid beneficiaries in New York City and New York state. JAMA Health Forum2021;2:e210342.
KoH, GliedSA. Associations between a New York City paid sick leave mandate and health care utilization among Medicaid beneficiaries in New York City and New York state. JAMA Health Forum 2021;2:e210342.10.1001/jamahealthforum.2021.034235977312)| false
Society for Human Resource Management. State by state: paid sick leave. Accessed September 12, 2021. Available at:https://www.shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/state-local-paid-sick-leave-chart.aspx)| false