Association between cost and insurance on receipt of guideline-concordant mammography.

Abstract

11078 Background: Many organizations offer mammography guidelines with slight differences, which can serve as a barrier to receiving a mammogram. Furthermore, it is unknown how both cost and insurance serve as a barrier to receiving a mammogram. Therefore, our study explored the associations between cost and insurance on guideline-concordant mammography. Methods: This cross-sectional study used 2023 National Health Interview Survey data. Inclusion criteria included women eligible for a mammogram. The outcome was receipt of guideline-concordant mammography and was based on women following 2016 US Preventive Services Task Force or current American Cancer Society guidelines for age and frequency requirements. The exposures of interest included report of at least one healthcare-related cost issue (yes, no) and insurance status (uninsured, insured). Questions for healthcare-related cost issue included: in the past 12 months did you, 1) have problems paying or were unable to pay medical bills, 2) delayed medical care due to cost, & 3) did not get necessary medical care due to cost. We estimated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression to assess the interaction between cost issues and insurance status on receipt of guideline-concordant mammography. The model controlled for age at survey completion, race and ethnicity, Rural-Urban Classification Scheme, income to poverty ratio, and personal & family history of breast cancer. Results: A total of 13,529 women were included. Mean age was 55 years, 63% were non-Hispanic White, 10% were in poverty. About 1 in 4 had not received guideline concordant mammography. When compared to those who had received a guideline-concordant mammogram, individuals who did not have a mammogram were younger (p-value: <.0001), uninsured (<.0001), and had reported at least one cost issue (<.0001). In our adjusted analysis, we found that the uninsured, regardless of cost issue, had lower odds of receipt of guideline-concordant mammography (Table). Among insured individuals, those who did vs did not report a cost issue had 0.68 (95% CI 0.59-0.77) times the odds of receipt of a guideline-concordant mammogram. Conclusions: By interacting cost issues and insurance status, we found that individuals with health insurance and issues paying for care had low prevalence of guideline-concordant mammography. This is important when determining how best we can provide screening for those in need. We recommend that screening services that offer free or low-cost mammograms include women who have health insurance and report healthcare-related cost issues. Model results (N=13529). OR(95% CI) Healthcare-related cost issue Uninsured vs insured 0.59 (0.43-0.81) No healthcare-related cost issue Uninsured vs insured 0.46 (0.35-0.60) Uninsured Healthcare-related cost issue vs none 0.87 (0.60-1.27) Insured Healthcare-related cost issue vs none 0.68 (0.59-0.77)