Mammography utilization in 2000-2005: Trends and disparities in different state policy environments

Significance: Screening is essential for early detection of breast cancer, but national rates fell 2000-2005.

Objective(s): We study predictors of breast cancer screening to determine the relative contributions of personal, environmental, and policy variables over time (2000-2005). We include state-level generosity in providing assistance paying Part B Medicare premiums to needy elderly and state's history of comprehensive cancer control efforts targeted to breast cancer screening. The study population includes 185,936 women age 65+ living during 2000-2005 in 11 states that span all census regions with heterogeneous socio-demographics.

Methods: We use multilevel logistic regression of a binary probit choice model over two time intervals (2000-2002, 2003-2005) and assess empirically whether predicted effects are different across states and time, analyzing these differences in the context of different state policy environments.

Results: African American women have significantly lower probability of use in four states, but significantly higher and increasing probability of use in Michigan - the earliest state to enact CCC policies aimed at increasing mammography use among needy women. Women in all states showed lower average propensities to utilize mammography than women in California, but over time screening rates increased (relative to California), and disparities in minorities (relative to whites) decreased.

Conclusions: This study is the first to examine the impact of two different sorts of policy levers on the propensity of women aged 65+ to use mammography services. Findings suggest that women benefited from the policies enacted during this period, as mammography rates increased and disparities in them decreased over time.