Medicaid Expansion and Breast Cancer Screening in Appalachia and Non-Appalachia, United States, BRFSS 2003 to 2015

Valvi, Nimish R; Vin-Raviv, Neomi; Akinyemiju, Tomi

doi:10.1177/1073274819845874

Cited by 9 publications

(6 citation statements)

References 43 publications

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“…In the states that elected to participate in Medicaid expansion, women with Medicaid are similarly afforded breast cancer screening services at no cost (Kaiser Family Foundation, 2019). Despite increases in Medicaid enrollment in states that expanded Medicaid, Behavioral Risk Factor Surveillance System data reveal small or not significant increase in rates of breast cancer screening for low-income women ages 40 to 64 in these states compared with nonexpansion states (Alharbi et al., 2019; Hendryx, 2018; Valvi et al., 2019). Furthermore, the ACA established the Prevention and Public Health Fund to support statewide, territorial, and tribal health programs to improve breast cancer detection, outreach, and education (U.S.…”

mentioning

confidence: 91%

Access to Care as a Barrier to Mammography for Black Women

Aleshire

Adegboyega

Escontrías

et al. 2020

Policy, Politics, & Nursing Practice

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Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women’s mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas’ conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.

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mentioning

confidence: 91%

Access to Care as a Barrier to Mammography for Black Women

Aleshire

Adegboyega

Escontrías

et al. 2020

Policy, Politics, & Nursing Practice

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“…A Behavioral Risk Factor Surveillance System (BRFSS) study of women aged 50–74 years found significantly lower breast cancer screening rates in non-expansion than expansion states for non-Appalachian states (2011 to 2015) (RR = 0.95, 95% CI: 0.95–0.96) [ 40 ]. Likewise, white and Latina women displayed higher screening rates in non-Appalachian expansion than non-expansion states (rate differences of at least 3.4%), though differences were minimal for African Americans in non-Appalachian states and all groups in Appalachian states.…”

Section: Resultsmentioning

confidence: 99%

Medicaid Expansions: Probing Medicaid’s Filling of the Cancer Genetic Testing and Screening Space

et al. 2022

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Cancer is the third largest source of spending for Medicaid in the United States. A working group of the American Public Health Association Genomics Forum Policy Committee reviewed 133/149 pieces of literature addressing the impact of Medicaid expansion on cancer screening and genetic testing in underserved groups and the general population. Breast and colorectal cancer screening rates improved during very early Medicaid expansion but displayed mixed improvement thereafter. Breast cancer screening rates have remained steady for Latina Medicaid enrollees; colorectal cancer screening rates have improved for African Americans. Urban areas have benefited more than rural. State programs increasingly cover BRCA1/2 and Lynch syndrome genetic testing, though testing remains underutilized in racial and ethnic groups. While increased federal matching could incentivize more states to engage in Medicaid expansion, steps need to be taken to ensure that they have an adequate distribution of resources to increase screening and testing utilization.

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“…Uninsurance or underinsurance is associated with other social determinants of health such as belonging to a minority racial group, having a lower educational status, or earning a lower wage [ 18 , 19 ]. These characteristics predispose patients to a decreased potential of upward social mobility, influencing their overall socioeconomic status and directly obstructing access to preventive care or appropriate screening for their high risk status.…”

Section: Discussionmentioning

confidence: 99%

“…These characteristics predispose patients to a decreased potential of upward social mobility, influencing their overall socioeconomic status and directly obstructing access to preventive care or appropriate screening for their high risk status. Although non-Medicaid expansion states like Alabama did not receive additional funding to expand women’s preventive services, many non-Medicaid expansion states still experienced an increase in insurance utilization following Medicaid-expansion, likely due to the increased awareness of insurance accessibility and importance of preventive healthcare initiatives popularized by the ACA [ 18 ]. In light of the central drive for Medicaid-expansion, if Alabama were to expand Medicaid, its citizens could experience increased insurance access and access to breast cancer screening modalities, incur lower incidences of late-stage breast cancer diagnoses, and become a more health-informed population [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Affordable Care Act provisions on the racial makeup of patients enrolled at a Deep South, high-risk breast cancer clinic

Tinglin,

McLeod,

Williams

et al. 2023

Preprint

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Purpose Black women are less likely to receive screening mammograms and are at a higher lifetime risk for developing breast cancer compared to their White counterparts. Affordable Care Act (ACA) provisions decreased cost sharing for women’s preventive screening, potentially mitigating screening disparities. We examined enrollment of a high-risk screening program before and after ACA implementation stratified by race. Methods This retrospective, quasi-experimental study examined the ACA’s impact on patient demographics at a high-risk breast cancer screening clinic from 02/28/2003–02/28/2019. Patient demographic data were abstracted from electronic medical records and descriptively compared in the pre- and post-ACA time periods. Interrupted time series (ITS) analysis using Poisson regression assessed yearly clinic enrollment rates by race using incidence rate ratios (IRR) and 95% confidence intervals (CI). Results 2,767 patients enrolled in the clinic. On average, patients were 46 years old (SD, ± 12), 82% were commercially insured, and 8% lived in a highly disadvantaged neighborhood. In ITS models accounting for trends over time, Prior to ACA implementation, White patient enrollment was stable (IRR 1.01, 95% CI 1.00-1.02) while Black patient enrollment increased at 13% per year (IRR 1.13, 95% CI 1.05–1.22). Compared to the pre-ACA enrollment period, the post-ACA enrollment rate remained unchanged for White patients (IRR 0.99, 95% CI 0.97–1.01) but decreased by 17% for Black patients (IRR 0.83, 95% CI 0.74–0.92). Conclusion Black patient enrollment decreased at a high-risk breast cancer screening clinic post-ACA compared to the pre-ACA period, indicating a need to identify factors contributing to racial disparities in clinic enrollment.

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Medicaid Expansion and Breast Cancer Screening in Appalachia and Non-Appalachia, United States, BRFSS 2003 to 2015

Cited by 9 publications

References 43 publications

Access to Care as a Barrier to Mammography for Black Women

Access to Care as a Barrier to Mammography for Black Women

Medicaid Expansions: Probing Medicaid’s Filling of the Cancer Genetic Testing and Screening Space

Impact of Affordable Care Act provisions on the racial makeup of patients enrolled at a Deep South, high-risk breast cancer clinic

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