title: Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study.
abstract: OBJECTIVE
  There is evidence to suggest that mammography rates are decreased in women with diabetes and in women of lower socio-economic status. Given the strong association between low socio-economic status and diabetes, we explored the extent to which differences in socio-economic status explain lower mammography rates in women with diabetes.
  
  
  METHODS
  A population-based retrospective cohort study in Ontario, Canada, of women aged 50 to 69 years with diabetes between 1999 and 2010 age matched 1:2 to women without diabetes. Main outcome measure is the likelihood of at least one screening mammogram in women with diabetes within a 36-month period, starting as of either 1 January 1999, their 50th birthday, or 2 years after diabetes diagnosis--whichever came last. Outcomes were compared with those in women without diabetes during the same period as their matched counterparts, adjusting for socio-economic status based on neighbourhood income and other demographic and clinical variables.
  
  
  RESULTS
  Of 504,288 women studied (188,759 with diabetes, 315,529 with no diabetes), 63.8% had a screening mammogram. Women with diabetes were significantly less likely to have a mammogram after adjustment for socio-economic status and other factors (odds ratio 0.79, 95% CI 0.78-0.80). Diabetes was associated with lower mammogram use even in women from the highest socio-economic status quintile (odds ratio 0.79, 95% CI 0.75-0.83).
  
  
  CONCLUSIONS
  The presence of diabetes was an independent barrier to breast cancer screening, which was not explained by differences in socio-economic status. Interventions that target patient, provider, and health system factors are needed to improve cancer screening in this population.
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Chan
authors.forename: L
authors.initials: L
authors.lastname: Yun
authors.forename: P C
authors.initials: PC
authors.lastname: Austin
authors.forename: R L
authors.initials: RL
authors.lastname: Jaakkimainen
authors.forename: G L
authors.initials: GL
authors.lastname: Booth
authors.forename: J
authors.initials: J
authors.lastname: Hux
authors.forename: P A
authors.initials: PA
authors.lastname: Rochon
authors.forename: L L
authors.initials: LL
authors.lastname: Lipscombe
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D012959:Socioeconomic Factors