title: The Role of Socioeconomic Status and Health Care Access in Breast Cancer Screening Compliance Among Hispanics.
abstract: OBJECTIVE
  Considerable disparities in breast cancer screening exist between Hispanic and non-Hispanic white (NHW) women. Identifying and quantifying the factors contributing to these racial-ethnic disparities can help shape interventions and policies aimed at reducing these disparities. This study, for the first time, identified and quantified individual-level sociodemographic and health-related factors that contribute to racial-ethnic disparities in breast cancer screening using the nonlinear Blinder-Oaxaca decomposition method.
  
  
  METHODS
  Analysis of the retrospective pooled cross-sectional Medical Expenditure Panel Survey data from 2000 to 2010 was conducted. Women aged 40 years and older were included in the study. Logistic regressions were used to estimate racial-ethnic disparities in breast cancer screening. Nonlinear Blinder-Oaxaca decomposition method was used to identify and quantify the contribution of each individual-level factor toward racial-ethnic disparities.
  
  
  RESULTS
  Based on the unadjusted analyses, Hispanic women had lower odds of receiving mammogram screening (MS) (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.69-0.80) and breast cancer screening (OR: 0.75; 95% CI: 0.70-0.81) as compared with NHW women. However, the relationship reversed in adjusted analyses, such that Hispanic women had higher odds of receiving MS (OR: 1.27; 95% CI: 1.16-1.40) and breast cancer screening (OR: 1.28; 95% CI: 1.17-1.40) as compared with NHW women. The Blinder-Oaxaca decomposition estimated that improving insurance status, access to care, education, and income will considerably increase screening rates among Hispanic women.
  
  
  CONCLUSIONS
  The study projects that improving health care access and health education will considerably increase breast cancer screening compliance among Hispanic women. Policies like the Affordable Care Act, and patient navigation and health education interventions, might considerably reduce screening disparities in the Hispanic population.
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston (Ms Jadav, Dr Abughosh, and Dr Sansgiry) and Department of Management, Policy & Community Health, The University of Texas Health Science Center at Houston (Dr Rajan).
authors.forename: Smruti
authors.initials: S
authors.lastname: Jadav
authors.forename: Suja S
authors.initials: SS
authors.lastname: Rajan
authors.forename: Susan
authors.initials: S
authors.lastname: Abughosh
authors.forename: Sujit S
authors.initials: SS
authors.lastname: Sansgiry
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D014481:United States / Q000453:epidemiology