Abstract B86: Disparities in mammogram screening among women with access to care: The role of socioeconomic status and education
Authors: Vichare Anushree 
Published: May 2016

Abstract
Purpose: Differences in mammogram screening (MS) rates are well documented. While multiple barriers limit screening, lack of health insurance has been identified as a main reason. However, even among women with health insurance, only 71 percent had a mammogram within the past two years. Understanding factors affecting screening beyond access to care are therefore imperative to reduce the gap. This study's objectives are three-fold: 1) To explore barriers to mammogram screening (MS), 2) To examine disparities in MS among women with insurance coverage and a usual source of care (USC) and 3) To study the association between provider characteristics with the receipt of timely MS.
Methods: An unweighted analytic sample of 24475 women, 50 years and older was identified using the 2007-2012 pooled cross-sections of the Medical Expenditure Panel Survey (MEPS). Mammogram screening was measured by the respondent's answer to the survey question “how long since the last mammogram”. Based on the 2009 U.S Preventive Services Task Force's breast cancer screening recommendations, responses were coded as “timely” if it was indicated that a mammogram was received at least within the past two years. Logistic regressions were used to examine the factors associated with the probability of MS.
Results: The mean age of the cohort was 64years (+/-0.15) with a majority (77%) of non-Hispanic whites (NHW), 10% non-Hispanic blacks (NHB), 8% Hispanics while the remaining 6% indicated other races. Overall, the study population had at least a high school education but about 30% reported an income below 200% of the federal poverty level. While women in this cohort primarily had private insurance (66%), 27% were on public insurance, 10% reported not having a USC and most women had a good health status (81%). 24% women reported not receiving a timely MS. Regression results demonstrated that being a NHW, lower socio-economic status (SES), living in the rural areas, having less than 12 years of education, being uninsured, reporting poor physical health status and not having a USC lowered the probability of receiving timely screening. Disparities in MS persisted even among those women with insurance coverage and a USC. Interestingly, in this cohort, NHB and Hispanic women continued to have higher odds of MS (OR: 1.63; 95% CI: 1.42-1.88 and OR:1.61; 95% CI:1.35-1.91 respectively) compared to NHW. However, the most notable and significant differences were found based on SES and the education level even after adjusting for other variables. For example, women in low SES and those without any education had approximately 43% lower odds of receiving MS compared to those in higher SES and those with at least a high school education. To further explore disparities in MS, regression analysis will incorporate system-level factors such as characteristics of the usual source of care and provider's communication skills to examine the association of racial/sex concordance, provider's specialty and patient satisfaction with the quality of care with the receipt of a timely mammogram.
Conclusions: Improving access to mammography is an important health policy concern. The crucial role of insurance coverage and access to primary care cannot be undermined. However, social determinants such as education and socio-economic level are also vital as lack of awareness and poor knowledge regarding breast cancer screening, language and financial barriers continue to persist among the vulnerable population. Particularly in women with a usual source of care, provider recommendations and improving patient's satisfaction with care can prove vital to boost timely screening by building trust in the healthcare system. Thus, recognizing predictors of mammogram even after providing access to care may improve utilization of screening mammography among the underserved women.
Citation Format: Anushree Vichare. Disparities in mammogram screening among women with access to care: The role of socioeconomic status and education. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B86.