Disparities in Breast Cancer Screening Rates are Compounded by Type of Insurance Coverage and Social Drivers of Health
Author(s)
Christie Teigland, MA, PhD1, Zulkarnain Pulungan, PhD2, Emma Pennington, PhD, PharmD2.
1Vice President, Research Science and Advanced Analytics, Inovalon, Bowie, MD, USA, 2Data Insights, Inovalon, Bowie, MD, USA.
1Vice President, Research Science and Advanced Analytics, Inovalon, Bowie, MD, USA, 2Data Insights, Inovalon, Bowie, MD, USA.
OBJECTIVES: Breast cancer accounts for about 30% of new cancers annually among women in the United States and is the second leading cause of cancer deaths. Breast cancer screening (BCS) is essential to early diagnosis and treatment which improves outcomes and reduces mortality. However, screening rates vary widely. This study expands on existing analyses by evaluating 7-year trends (2017-2023) in BCS across four major insurance types (Medicare Fee-for-Service (FFS), Medicare Advantage (MA), Commercial, and Medicaid).
METHODS: Retrospective analysis used nationally representative data linked to 9-digit ZIP neighborhood-level social drivers of health (SDOH) using patients’ addresses. Rates by payer/year were further stratified by age group, income, education, English proficiency, living alone, and region/state.
RESULTS: BCS rates are consistently lowest (40-55%) among the Medicaid insured. BCS rates are higher in 2023 compared to 2017 across most payers and age groups, but disparity gaps did not improve. For example, among women 50-64, rates increased by 2.6 percentage points (PP) in both commercial and Medicaid insured, but the disparity gap stayed constant at 18.9 PP (67.3% vs 48.4% and 69.9% vs 51.0% respectively). While the association of higher screening rates with higher income is strong among commercial and Medicare insured, rates are flat across income-levels in Medicaid. Regional disparities in screening rates are large ranging from 5.9% of Medicaid insured women in Alaska to 78.2% of commercially insured women in Massachusetts. BCS rates are consistently low in non-Medicaid expansion states, all but two falling in the bottom half (Wisconsin rank 8; Texas rank 24). Tennessee, Kansas, and Wyoming rank at the bottom.
CONCLUSIONS: BCS rates are consistently lowest among Medicaid insured women across SDOH including income, education, English proficiency, and household composition. Providers/payers should identify barriers in their populations and implement solutions to achieve health equity for all women regardless of social status or insurance coverage.
METHODS: Retrospective analysis used nationally representative data linked to 9-digit ZIP neighborhood-level social drivers of health (SDOH) using patients’ addresses. Rates by payer/year were further stratified by age group, income, education, English proficiency, living alone, and region/state.
RESULTS: BCS rates are consistently lowest (40-55%) among the Medicaid insured. BCS rates are higher in 2023 compared to 2017 across most payers and age groups, but disparity gaps did not improve. For example, among women 50-64, rates increased by 2.6 percentage points (PP) in both commercial and Medicaid insured, but the disparity gap stayed constant at 18.9 PP (67.3% vs 48.4% and 69.9% vs 51.0% respectively). While the association of higher screening rates with higher income is strong among commercial and Medicare insured, rates are flat across income-levels in Medicaid. Regional disparities in screening rates are large ranging from 5.9% of Medicaid insured women in Alaska to 78.2% of commercially insured women in Massachusetts. BCS rates are consistently low in non-Medicaid expansion states, all but two falling in the bottom half (Wisconsin rank 8; Texas rank 24). Tennessee, Kansas, and Wyoming rank at the bottom.
CONCLUSIONS: BCS rates are consistently lowest among Medicaid insured women across SDOH including income, education, English proficiency, and household composition. Providers/payers should identify barriers in their populations and implement solutions to achieve health equity for all women regardless of social status or insurance coverage.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
SA52
Topic
Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology