Distance and mammogram utilization among unmarried middle-aged and older women

This study assessed the relationship between distance to FDA-certified mammography facilities and recent mammography utilization in a sample of middle-aged and older women from the Rhode Island Cancer Screening Project for Women. Study participants were aged 40-75 (N=568) and were currently unmarried (previously married or never-married). ARC/GIS was used to calculate distance between participants' homes and the nearest mammography facility. Distance was categorized in tertiles (Tertile 1=0-1 miles; Tertile 2=1-2 miles; Tertile 3=2-10 miles) to facilitate interpretation of results. Models were computed in three stages: (1) distance variables only; (2) adding individual-level control variables; and (3) adding neighborhood-level control variables. Logistic regression models were computed for recent mammography (past 2 years) against distance to the nearest facility. Greater distance from a facility was positively associated with recent mammography in all three models, though it achieved statistical significance only in Model 1 (Tertile 2 OR=1.76, 95% CI=1.00-3.09; Tertile 3 OR=2.37, 95% CI=1.29-4.33). In Models 2 and 3, older age, an index of screening avoidance behaviors, and an index of structural barriers to screening were negatively associated with recent mammography (p<0.05). Results suggest that in small, densely populated areas such as Rhode Island, greater distance may not represent a barrier to mammography, and barriers to mammography may be greatest for women living closest to facilities. Thus, outreach may be most needed in the immediate vicinity of mammography facilities.