title: Health insurance and household income associated with mammography utilization among American women, 2000 - 2008.
abstract: BACKGROUND
  National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided free or low-cost mammograms to low-income or no health insurance women in all of the states of the United States (US) since 1997. The objective of this study was to understand whether health insurance and annual household income impacted the mammography utilization since the implementation of NBCCEDP, in order to evaluate how the implementation of NBCCEDP impacted mammography utilization among American women.
  
  
  METHODS
  Data were from the database of Behavioral Risk Factor Surveillance System (BRFSS) of the CDC in US. Mammography utilization was measured by whether the American woman aged 40 to 64 years had the mammography within the last two years. The chi square test and multivariate Logistic regression were used to evaluate the associations between mammography utilization and health insurance, annual household income, and other factors for any given year.
  
  
  RESULTS
  From 2000 to 2008, the rate of mammography utilization among participants had a steady decrease on the whole from 86.7% to 83.8%. The results showed that the mammography utilization correlated significantly with health insurance and annual household income for any given year. The results also showed that compared with participants who were uninsured, those who were insured had a greater times higher rate of mammography in 2008 than any other year from 2000 to 2008, and compared with participants whose annual household income was below $15 000, those whose annual household income was above $50 000 had a greater times higher rate of mammography in 2008 than in 2004 and 2006.
  
  
  CONCLUSIONS
  Health insurance and annual household income impacted the mammography utilization for any given year from 2000 to 2008, and the implementation of NBCCEDP has not achieved its original goal on breast cancer screening.
authors.affiliation: School of Public Economics and Administration, Shanghai University of Finance and Economics, Shanghai 200433, China.
authors.forename: Da-Hai
authors.initials: DH
authors.lastname: Zhao
authors.forename: Zhi-Ruo
authors.initials: ZR
authors.lastname: Zhang
authors.forename: Ke-Qin
authors.initials: KQ
authors.lastname: Rao
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States