title: Mental illness and use of screening mammography among Medicaid beneficiaries.
abstract: BACKGROUND
  Disparities in receipt of preventive services by people with mental illness have been documented previously. However, whether these disparities extend to screening mammography among individuals experiencing comparable barriers to accessing care has not been examined fully.
  
  
  OBJECTIVE
  To determine whether disparities exist in receipt of screening mammography between women with and without mental illness enrolled in Medicaid, a program with documented potential to reduce healthcare disparities.
  
  
  METHODS
  Receipt of screening mammography was examined among women aged 50-64 years enrolled in Ohio's Medicaid program during the years 2002-2008 (n=130,088). Receipt of annual screening mammography was examined among those with at least one screening mammography during the study period. Mental illness was identified through diagnostic, service, and pharmacotherapy codes (n=61,661).
  
  
  RESULTS
  Compared to women without mental illness, more women with mental illness received at least one screening mammography during the study period (31.7% vs 38.1%, p<0.001). However, after adjusting for potential confounders, including the presence of comorbid conditions and length of enrollment in Medicaid, women with mental illness were 32% less likely to undergo at least one screening mammography (AOR=0.68, 95% CI=0.66, 0.70). Among those who received at least one screening mammography, fewer women with mental illness received screening mammography on an annual basis (5.9% vs 12.7%, p<0.001; AOR=0.53, 95% CI=0.49, 0.56). For all beneficiaries, each year of enrollment in Medicaid increased the likelihood of screening mammography use by at least 50%.
  
  
  CONCLUSIONS
  Medicaid beneficiaries with mental illness constitute a particularly vulnerable population for suboptimal breast cancer screening.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland OH 44106-4945, USA. skoroukian@case.edu
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.forename: Paul M
authors.initials: PM
authors.lastname: Bakaki
authors.forename: Negar
authors.initials: N
authors.lastname: Golchin
authors.forename: Carl
authors.initials: C
authors.lastname: Tyler
authors.forename: Sana
authors.initials: S
authors.lastname: Loue
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008484:Medicaid; D001523:Mental Disorders; D008875:Middle Aged; D009820:Ohio; D014481:United States