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Mammography facilities are accessible, so why is utilization so low?

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Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Objective

This study examines new socio-ecological variables reflecting community context as predictors of mammography use.

Methods

The conceptual model is a hybrid of traditional health-behavioral and socio-ecological constructs with an emphasis on spatial interaction among women and their environments, differentiating between several levels of influence for community context. Multilevel probability models of mammography use are estimated. The study sample includes 70,129 women with traditional Medicare fee-for-service coverage for inpatient and outpatient services, drawn from the SEER–Medicare linked data. The study population lives in heterogeneous California, where mammography facilities are dense but utilization rates are low.

Results

Several contextual effects have large significant impacts on the probability of mammography use. Women living in areas with higher proportions of elderly in poverty are 33% less likely to use mammography. However, dually eligible women living in these poor areas are 2% more likely to use mammography than those without extra assistance living in these areas. Living in areas with higher commuter intensity, higher violent crime rates, greater land use mix (urbanicity), or more segregated Hispanic communities exhibit −14%, −1%, −6%, and −3% (lower) probability of use, respectively. Women living in segregated American Indian communities or in communities where more elderly women live alone exhibit 16% and 12% (higher) probability of use, respectively. Minority women living in more segregated communities by their minority are more likely to use mammography, suggesting social support, but this is significant for Native Americans only. Women with disability as their original reason for entitlement are found 40% more likely to use mammography when they reside in communities with high commuter intensity, suggesting greater ease of transportation for them in these environments.

Conclusions

Socio-ecological variables reflecting community context are important predictors of mammography use in insured elderly populations, often with larger magnitudes of effect than personal characteristics such as race or ethnicity (−3% to −7%), age (−2%), recent address change (−7%), disability (−5%) or dual eligibility status (−1%). Better understanding of community factors can enhance cancer control efforts.

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Acknowledgments

This work was supported by a National Cancer Institute grant (5 R21 CA117869-02), “Spatial Impact Factors and Mammography Use.” The content is solely the responsibility of the authors and does not necessarily represent the official views of RTI International, the National Cancer Institute, or the National Institutes of Health. Databases developed under this funding with contextual variables defined at ZCTA, PCSA, MSSA (California) and county levels are available to interested researchers, who may send a self-addressed and stamped envelope with media (two 4.6 GB DVDs) to Dr. Mobley.

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Authors and Affiliations

  1. Public Health and Environment Division, RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA

    Lee R. Mobley, Tzy-Mey (May) Kuo & Laurel J. Clayton

  2. Department of Prevention and Community Health, George Washington University, School of Public Health and Health Services, 2121 I Street, N.W., Washington, DC, 20052, USA

    W. Douglas Evans

  3. Department of Global Health, George Washington University, School of Public Health and Health Services, 2121 I Street, N.W., Washington, DC, 20052, USA

    W. Douglas Evans

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  1. Lee R. Mobley
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  2. Tzy-Mey (May) Kuo
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  3. Laurel J. Clayton
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Correspondence to Lee R. Mobley.

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Mobley, L.R., Kuo, TM., Clayton, L.J. et al. Mammography facilities are accessible, so why is utilization so low?. Cancer Causes Control 20, 1017–1028 (2009). https://doi.org/10.1007/s10552-009-9295-1

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  • DOI: https://doi.org/10.1007/s10552-009-9295-1

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