Paid Sick Leave Among Working Cancer Survivors and Its Associations With Use of Preventive Services in the United States
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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.
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