title: Disparities in routine breast cancer screening for Medicaid managed care members with a work-limiting disability.
abstract: OBJECTIVE
  Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability.
  
  
  METHODS
  Individual-level data were obtained for women enrolled in Massachusetts Medicaid Managed Care plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screening measure (n=35,171). Disability status was determined from Medicaid eligibility records. Mammography screening was modeled using multivariate logistic regression. Separate models for women with and without a disability were also estimated.
  
  
  RESULTS
  Although unadjusted breast cancer screening rates were roughly equal for women with and without disability, after adjusting for confounders disability status had a significant negative association with screening mammography (OR=0.74; p<0.0001). Living farther from a mammography facility or having a diagnosis of domestic violence reduced the odds of screening for women with disabilities, but not for other women. Having a higher illness burden was more detrimental to screening for women with a disability than for those without. Both groups benefited similarly from the first 26 ambulatory care visits, but the impact of additional visits on screening was much larger among women with disabilities.
  
  
  CONCLUSIONS
  Nationwide, rates of routine mammography for Medicaid managed care plans averaged below 50% in 2006. Given that a majority of eligible women served by Medicaid have disabilities, and studies have shown that women with disabilities are more likely to be diagnosed with late stage disease, a focus on improving rates of screening for women with disabilities is overdue.
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA 01545, USA. Sharada.weir@umassmed.edu
authors.forename: Sharada
authors.initials: S
authors.lastname: Weir
authors.forename: Heather E
authors.initials: HE
authors.lastname: Posner
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhang
authors.forename: Whitney C
authors.initials: WC
authors.lastname: Jones
authors.forename: Georgianna
authors.initials: G
authors.lastname: Willis
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Baxter
authors.forename: Robin E
authors.initials: RE
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008404:Massachusetts / Q000453:epidemiology; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States / Q000453:epidemiology