City Patterns of Screening Mammography Uptake and Disparity across the United States

Background Although previous studies have focused on rural disparities in the use of screening mammography, city-level use throughout the United States has not been well evaluated even though more than 30 million women live in the 500 largest cities. Purpose To evaluate disparities in the city-level use of screening mammography and to identify factors that have an impact on screening utilization. Materials and Methods This retrospective study used data from large publicly available databases, the American Community Survey and Robert Wood Johnson Foundation 500 Cities Project, which includes screening mammography utilization data from the Behavioral Risk Factor Surveillance System. Databases were searched from January to March 2018. The use of screening mammography was evaluated at the city level by census region and division by using the Mann-Whitney U test. Univariable Spearman rank correlation and multivariable regression analysis were performed to determine the impact of factors on screening use, including population size, health-related variables (use of Papanicolaou test, obesity), income variables (median household income, poverty status, health insurance), and race. Results Overall mean city-level screening mammography use rate was 77.7% (range, 62.8%-88.9%). The highest mean utilization occurred in coastal cities, with the highest overall utilization in the New England area (82.7%). The lowest utilization rate was in Mountain states (73.6%). City-level utilization showed a positive correlation with Papanicolaou test use (r = 0.75, P < .001), median household income (r = 0.44, P < .001), and percentage Asian population (r = 0.38, P < .001) and a negative correlation with obesity (r = -0.36, P < .001), the lack of health insurance (r = -0.44, P < .001), and poverty (r = -0.30, P < .001). Multivariable analysis showed the strongest independent predictors of utilization to be percentage of women screened with the Papanicolaou test, Asian race, private insurance, and census division (R2 = 68%). Conclusion Disparities in the utilization of preventive health care services exist at the large city level, with the highest use in New England cities and lowest in Mountain cities. Predictors of higher than average utilization include census division and percentage of inhabitants who are up to date with the Papanicolaou test, are of Asian race, and have private insurance. © RSNA, 2019.