Household bargaining over screening for bowel cancer: Evidence from the English Longitudinal Study of Ageing

Background:
Health behaviours depend upon preferences and individuals’ assessments of the long-term costs and benefits for their own health and the welfare of other members of their household. Thus, we would expect household bargaining over health behaviours. However, there is little evidence on its extent. We examine within-household correlation in the uptake of bowel cancer screening, a free, non-invasive and self-administered home-based test that has proven effective in detecting cancer at early stages and hence reducing related mortality.


Objective:
Between 2010 and 2021, the NHS Bowel Cancer Screening Programme in England targeted people aged 60 to 74 years. People were invited individually to take part. We explore the nature and the extent of partners’ influence, studying whether screening and other health behaviours among partners influence participation decisions.


Methods:
We use information on 2,509 respondents to the English Longitudinal Study of Ageing (ELSA) across three waves (2010/2011, 2012/2013 and 2014/2015). We exploit the sharp age cut-off for screening programme eligibility at age 60 and use a regression discontinuity approach to study how the decision to start screening depends upon partner’s programme eligibility, uptake and other health behaviours. Our main analysis studies the influence of older on younger partners, contrasting the behaviour of couples with singles, for individuals aged 55 to 64.


Results:
Results suggest that individuals with screened older partners are 25.7% more likely (p<0.01) to participate in the screening programme compared to singles, and 31.5% (p<0.01) compared to individuals with non-screened older partners. The latter are 5.82% less likely compared to singles, although this result is not statistically significant. We find evidence that screening uptake depends on partner’s health behaviours, especially when the partner smokes. In an additional analyses, we also study the response of previously unscreened older individuals to the Bowel Cancer Screening Program eligibility of their younger partners. We show that older partners display differences in screening participation (across younger partner’s screening behaviours) comparable to our main results.


Discussion:
Household bargaining has a substantial influence on participation in bowel cancer screening. Partner participation results in higher uptake overall. Partner non-participation is detrimental for younger partners, whose uptake drops below the level for comparable singles under certain circumstances. Finally, partner health behaviours predict concordance in screening uptake within couples. The discussion will try to reconcile our empirical results with the main theoretical mechanisms of household bargaining around health behaviours.

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