Explaining variation across grantees in breast and cervical cancer screening proportions in the NBCCEDP

Abstract

Purpose There is substantial variation across the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) grantees in terms of the proportion of the eligible population served by the grantees each year (hereafter referred to as the screening proportion). In this paper, we assess program- and state-level factors to better understand the reason for this variation in breast and cervical cancer screening proportions across the NBCCEDP grantees. Methods We constructed a longitudinal data set, consisting of data from NBCCEDP grantees for each of the three study years (program-years 2006–2007, 2008–2009, and 2009–2010). We performed multivariate analysis to explain the variation in breast and cervical cancer screening proportions across the grantees. The program-level factors studied were the total federal funds received, average cost of screening women by grantee, and the overall organizational structure. The state-level variables included were urban versus rural mix, access to care, and the size of the eligible population. Results Of the 48 grantees included in the study, those that serve larger populations, as measured by the size of the population and the percentage of women eligible for services, had lower screening proportions. Higher average cost of service delivery was also associated with lower screening proportions. In addition, grantees whose populations were more concentrated in urban areas had lower screening proportions. Conclusions Overall, the average cost of screening, the overall size of the population eligible, and the concentration of population in urban areas all had a negative relationship to the proportion of eligible women screened by NBCCEDP grantees.

Preventing premature deaths from breast and cervical cancer among underserved women in the United States: insights gained from a national cancer screening program

“…Subramanian et al [12] examined the factors associated with this variability and identified several program and state-level characteristics as important. A larger number of eligible women, a higher average cost of screening (which includes the cost of screening and diagnostic evaluation and cost of program operations), and a greater proportion of women in urban areas all were associated with a lower proportion of eligible women being screened.…”

The Reach and Health Impacts of the National Breast and Cervical Cancer Early Detection Program

“…These articles examine the proportions of women who are eligible for the NBCCEDP and who have been screened for breast and cervical cancer, as well as trends in these proportions during 1997–2012 [3, 4]. Subramanian et al [5] examine program and state-level factors in an effort to better understand reasons for state variation in the proportion of eligible women screened by the NBCCEDP. Dalzell and colleagues provide an in-depth description of the methods and data sets used to generate estimates of the number of women eligible for screening in the NBCCEDP [6].…”

Racial/Ethnic Disparities in Cervical Cancer Screening Services Among Contractors of the Connecticut Breast and Cervical Cancer Early Detection Program

“…Subramanian et al conducted a study to identify factors associated with variation in screening practices across NBCCEDP grantees and found that the size of the eligible patient population, cost of service delivery, and urban versus rural mix of patients all impacted practice. 18 Upon identifying extensive variation in HPV co-testing uptake among the Connecticut contractors, it may be important to explore the organizational and systems-level factors that could be contributing to these contractor-level differences. While Connecticut is a relatively small state, each contractor does have unique characteristics, including population served and available resources in the local community.…”