Mediating Factors in the Relationship between Income and Mammography Use in Low-Income Insured Women

Abstract

Aim: We used secondary data from a prospective randomized mammography recruitment trial to examine whether attitudinal and facilitating characteristics mediate the observed relationship between annual household income and mammogram receipt among women in an integrated health plan. Methods: We compared 1419 women due for a screening mammogram based on the 1995 annual household income poverty definition for a family of four (Ͻ$15,000 vs. Ͼ$15,000). A telephone survey was used to collect information on household income, demographics, health behavior, attitudinal and facilitating variables. Administrative databases were used to document mammography receipt. We used Cox proportional hazards models to estimate the hazards ratio (HR) and 95% confidence interval (CI) of subsequent mammography use separately for women with and without a prior mammogram. Results: Several variables, including employment, living alone, believing that mammograms are unnecessary, having friends supportive of mammography, and ease of arranging transportation, completely mediated the effect of income on mammography use. In multivariable models, the direct predictive effect of income on mammography was reduced to nonsignificance (HR 1.13, 95% CI 0.82-1.54 in women with previous mammogram and HR 0.91, 95% CI 0.41-2.00 in women without previous mammogram). Conclusions: Providing insurance does not ensure low-income populations will seek screening mammography. Efficacious interventions that address attitudes and facilitating conditions may motivate mammography use among low-income women with insurance.

Underutilization of Supplemental Magnetic Resonance Imaging Screening Among Patients at High Breast Cancer Risk

“…Additional reported barriers to supplemental screening include lack of a primary care provider, lack of health insurance, associated out-of-pocket costs, anxiety related to MRI exams, and lack of social support, although these factors were not assessed in our study. 27 Multispecialty breast centers and full diagnostic radiology practices represented the most common practice types to offer breast MRI screening, reflecting their propensity for early adoption of advanced imaging modalities for new indications such as screening. 26 Most facilities offering supplemental MRI screening were also located in urban settings.…”

A Study on the Knowledge, Perception, and Use of Breast Cancer Screening Methods and Quality of Care Among Women from Central Mexico

“…In particular, women with low-income levels are less likely to use screening than women with higher income levels [12, 16]. Findings from the Encuesta Nacional de Salud y Nutrición 2012 [17] conducted by the Instituto de Salud Pública showed that women of higher economic status had more breast screening procedures than those of lower economic status.…”

The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography

“…Thus, our proximity-based measure captures potential access, which is likely to be included in women’s decision making about seeking services. We were not able to account for the specific mode of transportation, or the actual use of specific transportation; transportation has been shown to be associated with mammography receipt previously available in our membership [32]. Also, our study only included women with definitive breast cancer surgery, and thus would not account for the effect of travel time on breast cancer treatment among women who do not undergo surgery.…”