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Mammography Use Linked to Social Determinants, Revealing Need to Bridge Gaps With Community Support

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While mammograms are crucial for early detection of breast cancer and can save lives, social determinants of health and health-related social needs create barriers to access, especially for those with financial hardship, lack of transportation, or social isolation.

Mammogram breast screening | Image Credit: Dmitry Kovalchuk - stock.adobe.com

Mammogram breast screening | Image Credit: Dmitry Kovalchuk - stock.adobe.com

Mammography use is associated with decreased deaths caused by breast cancer, but social determinants of health (SDOH) and health-related social needs (HRSNs) present barriers to receiving mammography, according to new CDC data. Therefore, health care providers, social services, community organizations, and public health programs need to offer services to address these issues.

The 2022 Behavioral Risk Factor Surveillance System (BRFSS) data, reviewed by CDC researchers, estimated the prevalence of mammography use within the previous 2 years among women aged 40 to 74 years based on jurisdiction, age, and sociodemographic factors.

Mammograms, capable of early detection of breast cancer, are suggested for patients aged 50 to 74 at least every 2 years. However, SDOH, defined as the conditions where people are born, live, learn, work, play, worship, and age, can affect health, function, and quality of life outcomes. In addition, HRSNs are adverse social conditions on an individual level that can negatively affect a person’s health or health care access. The study set out to investigate mammography use and specific SDOH and HRSN barriers.

A total of 117,466 patients aged between 40 and 74 years were among the study population. Across states, Rhode Island represented the highest population of women aged 50 to 74 years who received mammography within the previous 2 years (85.5%) and South Dakota (77.8%) had the highest rate among women aged 40 to 49 years. The states with the lowest rate for these age groups were Wyoming (64.0%) and New Mexico (44.5%), respectively. The only states in which women aged 40 to 49 years had higher rates of mammography use compared with women aged 50 to 74 years were Mississippi, Pennsylvania, and South Dakota.

Black women in both the 40-to-49 and 50-to-74 age groups had the highest prevalence of mammography use within the previous 2 years (65.2% and 82.9%, respectively). The higher the educational attainment and increased income of patients, the more likely it was that they received mammograms over the past 2 years. Women among both age groups who did not have access to health insurance had reduced mammography participation (40-49 years: 32.7% vs 58.7%; 50-74 years: 37.4% vs 73.9%) and so did patients who did not have personal health care providers (32.7% vs 63.4% and 42.2% vs 79.1%) in comparison with those who did have access.

Mammography use prevalence decreased in women aged 50 to 74 years as the amount of SDOH and HRSNs increased. Patients who did not experience adverse SDOH or HRSNs had a median jurisdiction mammography use prevalence of 83.2% (range, 69.6%-91.0%). Among those with 1, 2, or 3 to 11 adverse SDOH or HRSNs, the median state mammography use prevalence rates were 77.1% (range, 57.9%-89.5%), 73.3% (range, 63.6%-83.5%), and 65.7% (range, 44.8%-83.8%).

Life dissatisfaction was a large barrier to mammogram use prevalence because the more socially isolated, unemployed, and financial obstacles a patient experiences, the less likely they are to get a mammogram. The study utilized a logistic regression model and found life dissatisfaction results were especially notable for women aged 40 to 49. In women aged 50 to 74 years, associations with not having mammograms over the past 2 years were found for lacking reliable transportation, cost barriers, social isolation, unemployment, food stamps, and other forms of life dissatisfaction. The factor with the strongest association with poor mammogram access among women in both age groups was financial hardships.

Study limitations were largely due to the BRFSS’ use of self-reported data not verified through medical records, which could result in over- or underestimation of mammography use. The study also may have a large portion of women at high risk for breast cancer development, therefore frequent screening recommendations were not noted. Generalizability is limited because SDOH and HRSNs were not analyzed for all 50 states nor are they specifically related to mammography use. Lastly, the BRFSS response rate was 45% and may not represent the total adult population in the findings.

The study highlights the importance of a better understanding and spread of information on SDOH and HRSNs to improve policies while funds are allocated toward community organizations focused on the targeted needs of diverse patient populations. If health care providers, facilities, and public health programs address SDOH and HRSNs, then they may have the potential to increase mammogram prevalence and other preventive health services.

Reference

Miller JW, King JA, Trivers KF, et al. Vital Signs: mammography use and association with social determinants of health and health-related social needs among women — United States, 2022. MMWR Morb Mortal Wkly Rep. Published online April 9, 2024. doi:10.15585/mmwr.mm7315e1

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