Abstract B90: Mammography screening access among uninsured and limited English-speaking populations: Spatial findings from the Every Woman Counts No-Cost Mammography Program in California.
Authors: Nguyen Kim Hanh 
Published: August 2014

Abstract
Background: Racial/ethnic disparities in proximity to mammography facilities have been documented in the literature; however, disparities among uninsured, limited English-speaking (LEP) populations are largely unexamined. This paper analyses access including geographic distance to mammography services for a diverse population of women eligible for a state-funded breast cancer screening program in California.
Methods: Data from multiple sources including participant data from the Every Woman Counts (EWC) program were used. Ecological analyses were conducted to determine whether mammography facility availability varied by tract race/ethnicity composition, median income, and language proficiency. Regression models examined the associations of area sociodemogrpahic characteristics of the population on access to facilities and whether these variations differed for EWC-specific facilities, controlling for population and land mass. Also, average distances to the nearest mammography facility were computed for populations by race/ethnicity and primary language.
Results: Within the state, 736 mammography facilities were identified. Of these, a quarter were EWC-specific facilities (n=182); 156 reported at providing services in a language other than English. Among 14,905 women screened as eligible for the EWC program, 47% are Hispanic, 33% White; 9.2% Asian; and 6.3% Black. Overall there were significant differences in mammography facility availability by tract sociodemographic characteristics. For the regression examining having any mammography facility, there are apparent racial differences in facility access; census tracts with higher percentages of Hispanic (OR 0.54, 95% confidence interval [CI] =0.43, 0.67) or mixed residents (OR 0.80, CI: 0.66 0.96) are significantly less likely to have a mammography facility compared to predominately White census tracts. There was no association between tract level income, poverty levels, and linguistic isolation to any mammography facility. When associations between availability of facilities were investigated separately for EWC-specific facilities, we found that they are more likely to be present in neighborhoods with higher proportions of Asian residents than residents with other minority racial background. The average number of miles between EWC-eligible women and the nearest facility is 3.8 miles. Compared with English speakers, Spanish-speaking and Asian-speaking participants traveled a shorter distance to the nearest facility (English = 4.4 miles, Spanish = 3.1, Asian=2.6; P &lt; 0.001).
Not surprisingly, travel distance increased when evaluating the nearest EWC facility, with a mean travel distance of 7.3 miles to the nearest mammography facility across all census tracts. Among three language groups, the average distance to the nearest medical facilities were shortest in Asian speakers, 5.0 miles, then among Spanish speakers (6.2), and longest among English speakers (8.2). The shortest path by distance is similar for all but Asian speakers who had significantly longer average travel distances to a facility that had linguistic services in their language. For instance, the mean travel time for Asian speakers to a language-concordant facility is 18.7 miles which is longer than to a non-language specific EWC facility (5 miles) and to any mammography facility (2.6 miles).
Conclusion: Variation in access to mammography services suggest the importance of examining the spatial distribution of cancer screening services, especially those that are language-appropriate, to uninsured populations.
Citation Format: Kim Hanh Nguyen. Mammography screening access among uninsured and limited English-speaking populations: Spatial findings from the Every Woman Counts No-Cost Mammography Program in California. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B90.