Breast Cancer Screening Among Women with Medicaid, 2006-2008: a Multilevel Analysis.
Nationally, about one third of women with breast cancer (BC) are diagnosed at late stage, which might be reduced with greater utilization of BC screening. The purpose of this paper is to examine the predictors of BC mammography use among women with Medicaid, and differences among Medicaid beneficiaries in their propensity to use mammography.



The sample included 2,450,527 women drawn from both fee-for-service and managed care Medicaid claims from 25 states, during 2006-2008. The authors used multilevel modeling of predictors at person, county, and state levels of influence and examined traditional factors affecting access and the expanded scope of practice allowed for the nurse practitioner (NP) in some states to provide primary care independent of physician oversight.



Black [OR = 0.87; 95 % CI (0.87-0.88)] and American Indian women [OR = 0.74; 95 % CI (0.71-0.76)] had lower odds ratio of mammography use than white women, while Hispanic [OR = 1.06; 95 % CI (1.05-1.07)] had higher odds ratio of mammography use than white women. Living in counties with higher Hispanic residential segregation [OR = 1.16; 95 % CI (1.10-1.23)] was associated with a higher odds ratio of mammography use compared to areas with low Hispanic residential segregation, whereas living among more segregated black [OR = 0.78; 95 % CI (0.75-0.81)] or Asian [OR = 0.19; 95 % CI (0.17-0.21)] communities had lower odds ratio compared to areas with low segregation. Holding constant statistically the perceived shortage of MDs, which was associated with significantly lower mammography use, the NP regulatory variable [OR = 1.03; 95 % CI (1.01-1.07)] enhanced the odds ratio of mammography use among women in the six states with expanded scope of practice, compared with women residing in 19 more restrictive states.



Racial and ethnic disparities exist in the use of mammography among Medicaid-insured women. More expansive NP practice privileges in states are associated with higher utilization, and may help reduce rural disparities.
School of Public Health and Andrew Young School of Policy Studies, Georgia State University, PO Box 3982, 1 Park Place, Atlanta, GA, USA. lmobley@gsu.edu.
Lee Rivers
LR
Mobley
RTI International, Waltham, MA, USA.
Sujha
S
Subramanian
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Florence K
FK
Tangka
RTI International, Waltham, MA, USA.
Sonja
S
Hoover
RTI International, Waltham, MA, USA.
Jiantong
J
Wang
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Ingrid J
IJ
Hall
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Simple D
SD
Singh
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008484:Medicaid; D008875:Middle Aged; D055361:Multilevel Analysis; D014481:United States
Breast cancer screening; Medicaid; Multilevel analysis; Nurse practitioner regulation; Racial or ethnic disparities; Racial or ethnic residential segregation