Access to Care

Breast screenings are lower in counties with high rates of uninsured people

Women, regardless of income, who live in counties that have high rates of uninsured people are less likely to receive clinical breast exams or mammograms, a new study finds.

Mario Schootman, Ph.D., of Washington University in Missouri, and colleagues used data collected in the 2000 Behavior Risk Factor Surveillance System and the 1999-2001 Surveillance, Epidemiology, and End Results program to determine if screening for breast cancer varied by the proportion of uninsured in the community. As community residents who were uninsured increased by 5 percent, women were 5 percent less likely to be screened. Less screening also seemed to lead to lower diagnosis of breast cancer in its early stages. For example, the rate of early-stage (less than 2 cm diameter) tumors declined with the increasing proportion of uninsured in a county, regardless of poverty rate.

Surprisingly, breast cancer screening steeply declined for women with incomes from $25,000 to $75,000 living in counties with high rates of uninsured people. This could be due to their difficulty in finding care due to unavailable services or because their incomes preclude them from obtaining public health care. Their findings support the assertion that the health of all residents may be affected when there are high rates of uninsured people in a community. Race and ethnicity also seemed to be factors in screening rates. Black women and Hispanic women had higher screening rates than white women when they lived in communities where just 9 to 19 percent of the community was uninsured.

This study was funded in part by the Agency for Healthcare Research and Quality (HS14095).

See "Breast cancer screening and incidence in communities with a high proportion of uninsured," by Dr. Schootman, Mark S. Walker, Ph.D., Donna B. Jeffe, Ph.D., and others in the November 2007 American Journal of Preventive Medicine 33(5), pp. 379-386.

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