{
  "abstract": "Objective To examine the association between socioeconomic status (SES), financial subsidies and awareness-related factors such as age, cancer stage and family history, and the uptake of cancer genetic testing, with a focus on equitable access to care.Design Retrospective cohort study.Setting Tertiary care cancer genetics service in Singapore.Participants The study population included 2687 individuals of all ages, genders and ethnicities who attended pretest counselling between 2014 and 2020 and were eligible for genetic testing for hereditary cancer syndromes.Primary and secondary outcome measures The primary outcome was the uptake of genetic testing. The main explanatory variables were SES (proxied by Housing Index), subsidy status, age, cancer stage and family history. Analyses examined whether associations varied across SES and age subgroups.Results Receipt of financial subsidies was strongly associated with testing uptake (adjusted OR 9.15, 95% CI 2.68 to 31.20). Uptake exceeded 90% among subsidised individuals across all socioeconomic strata, compared with 56–68% among non-subsidised individuals, with the largest gains in the lowest SES group (43 vs 28 percentage points (pp) in the highest). The level of subsidy was not associated with uptake. Younger patients (18–39 years) had higher uptake than those aged 60+ (66% vs 57%); patients with advanced cancer (stage IV) had the highest uptake (82% vs 57–66% in earlier stages); and family history was associated with increased uptake, strongest for having a child with cancer (+28 pp). Interaction analysis suggested that the additive effects of subsidies were greatest in lower SES groups and in older adults.Conclusions Financial subsidies were strongly associated with higher genetic testing uptake. Awareness indicators like age, cancer stage and family history were associated with higher uptake. The association between subsidies and uptake varied by SES and age, suggesting that subsidies may help reduce disparities and improve equitable access to genetic testing services.",
  "authors": [
    {
      "affiliations": [
        "Division of Economics, Nanyang Technological University, Singapore"
      ],
      "name": "Akshar Saxena"
    },
    {
      "affiliations": [
        "Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore"
      ],
      "name": "Renne Phay"
    },
    {
      "affiliations": [
        "Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore",
        "Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore"
      ],
      "name": "Jianbang Chiang"
    },
    {
      "affiliations": [
        "Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore"
      ],
      "name": "Fuh Yong Wong"
    },
    {
      "affiliations": [
        "Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore"
      ],
      "name": "Jeanette Yuen"
    },
    {
      "affiliations": [
        "Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore"
      ],
      "name": "Diana Ishak"
    },
    {
      "affiliations": [
        "Lee Kong Chian School of Medicine (Population and Global Health), Nanyang Technological University, Singapore"
      ],
      "name": "Sara Tasnim"
    },
    {
      "affiliations": [
        "Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore",
        "Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore",
        "Lee Kong Chian School of Medicine (Population and Global Health), Nanyang Technological University, Singapore"
      ],
      "name": "Joanne Ngeow"
    }
  ],
  "title": "Does financial subsidy equalise cancer genetic testing uptake across socioeconomic groups? A retrospective observational study in Singapore",
  "uid": "fccb0c16-fb63-560a-87e8-4160cfb565d0"
}