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Lack of Community Insurance and Mammography Screening Rates Among Insured and Uninsured Women

José A. Pagán, David A. Asch, Cynthia J. Brown, Carmen E. Guerra, Katrina Armstrong

From the Department of Economics and Finance and Institute for Population Health Policy, College of Business Administration, University of Texas-Pan American, Edinburg, TX; Leonard Davis Institute of Health Economics; Division of General Internal Medicine, School of Medicine, University of Pennsylvania; Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA

Corresponding author: José A. Pagán, PhD, Department of Economics and Finance, College of Business Administration, University of Texas-Pan American, 1201 W University Drive, Edinburg, TX 78539; e-mail: jpagan{at}utpa.edu

Purpose To evaluate whether the proportion of the local population without health insurance coverage is related to whether women undergo mammography screening.

Methods Survey data on 12,595 women 40 to 69 years of age from the 2000 to 2001 Community Tracking Study Household Survey were used to analyze the relation between community lack of insurance and whether the respondent had a mammogram within the past year.

Results Women age 40 to 69 were less likely to report that they had a mammogram within the last year if they resided in communities with a relatively high uninsurance rate, even after adjusting for other factors. After adjusting for individual insurance and other factors, a 10-percentage-point decrease in the proportion of the local insured population is associated with a 17% (95% CI, 13% to 21%) decrease in the odds that a woman age 40 to 69 years will undergo mammography screening within a year.

Conclusion Women living in communities with high uninsurance are substantially less likely to undergo mammography screening. These results are consistent with the view that the negative impact of uninsurance extends to everyone in the community regardless of individual health insurance status.

Supported by the Department of Defense Breast Cancer Research Program under award number W81XWH-06-1-0334.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Views and opinions of, and endorsements by, the authors do not reflect those of the US Army or the Department of Defense.

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