Abstract C170: Association of marital status and living arrangement with adherence to all recommended cancer screenings

Abstract

Abstract Background: Many adults are concurrently eligible for multiple cancer screenings. Maximizing health benefits of cancer screening requires being up to date (UTD) for every test due. Marital status may confer social resources, such as screening reminders, encouragement, and assistance with scheduling and transportation, that support staying UTD across multiple tests. We examined the association of marital status and living arrangement with adherence to all recommended cancer screenings in a longitudinal setting. Methods: Using the Cancer Prevention Study-3 data (enrollment, 2006–2013; ages 30-65), we analyzed 139,444 cancer-free participants triennially in 2015–2021. At each survey wave, we included participants who were eligible for ≥2 screenings, up to 4 in females (breast, cervical, colorectal, and lung) and 3 in males (colorectal, prostate, and lung) using US Preventive Services Task Force recommendations. Complete adherence was defined as UTD for all recommended screenings. Sex-stratified modified Poisson models with generalized estimating equations estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association of time-dependent marital status and living arrangement at the preceding wave with complete adherence. Models were adjusted for race/ethnicity, family history of cancer, sexual orientation, insurance, education, census region, recent physical examination, and social health (social relationships satisfaction and social-role functioning). Results: During follow-up, 60.5% of males and 70.1% of females had complete multi-cancer screening adherence. In minimally adjusted models, unmarried participants were less likely than married participants to achieve complete adherence among both males (PR, 0.88; 95% CI, 0.85–0.91) and females (PR, 0.93; 95% CI, 0.92–0.93). Complete adherence was least likely among separated or divorced males (PR, 0.84; 95% CI, 0.80–0.88) and never-married females (PR, 0.88; 95% CI, 0.87–0.90). After adding living arrangement, complete adherence was less likely among unmarried males living with a partner (PR, 0.85; 95% CI, 0.80–0.92) and among unmarried participants of both sexes living with other family (males: PR, 0.86; 95% CI, 0.79–0.94; females: PR, 0.92; 95% CI, 0.91–0.94) or alone (males: PR, 0.92; 95% CI, 0.89–0.96; females: PR, 0.94; 95% CI, 0.93–0.95), compared with married participants with any living arrangement. These associations were modestly attenuated but generally persisted in fully adjusted models. Conclusion: Being married was associated with higher adherence to all recommended cancer screenings, whereas non-spousal co-residence did not consistently reproduce this pattern. Measured socioeconomic, healthcare-engagement, and social health factors did not fully account for these differences, suggesting contributions from support not captured by these measures, such as reminders, scheduling, transportation, advocacy, or navigation. Our results suggest that providing similar support, e.g., through patient navigation, by health systems may increase cancer screening utilization. Citation Format: Qinran Liu, Kierstin Faw, Jordan Baeker Bispo, Farhad Islami, Alpa Patel. Association of marital status and living arrangement with adherence to all recommended cancer screenings [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr C170.