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. 2018 Feb;28(2):65-71.e2.
doi: 10.1016/j.annepidem.2017.11.012. Epub 2017 Dec 7.

Geographic access to mammography facilities and frequency of mammography screening

Patricia I Jewett  1 , Ronald E Gangnon  2 , Elena Elkin  3 , John M Hampton  4 , Elizabeth A Jacobs  5 , Kristen Malecki  4 , James LaGro  6 , Polly A Newcomb  7 , Amy Trentham-Dietz  4
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Geographic access to mammography facilities and frequency of mammography screening

Patricia I Jewett et al. Ann Epidemiol. 2018 Feb.

Abstract

Purpose: To assess the association between geographic access to mammography facilities and women's mammography utilization frequency.

Methods: Using data from the population-based 1995-2007 Wisconsin Women's Health study, we used proportional odds and logistic regression to test whether driving times to mammography facilities and the number of mammography facilities within 10 km of women's homes were associated with mammography frequency among women aged 50-74 years and whether associations differed between Rural-Urban Commuting Areas and income and education groups.

Results: We found evidence for nonlinear relationships between geographic access and mammography utilization (nonlinear effects of driving times and facility density, P-values .01 and .005, respectively). Having at least one nearby mammography facility was associated with greater mammography frequency among urban women (1 vs. 0 facilities, odds ratio 1.26, 95% confidence interval, 1.09-1.47), with similar effects among rural women. Adding more facilities had decreasing marginal effects. Long driving times tended to be associated with lower mammography frequency. We found no effect modification by income, education, or urbanicity. In rural settings, mammography nonuse was higher, facility density smaller, and driving times to facilities were longer.

Conclusions: Having at least one mammography facility near one's home may increase mammography utilization, with decreasing effects per each additional facility.

Keywords: Health services accessibility; Mammography; Spatial epidemiology.

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Figures

Figure 1
Figure 1
Directed Acyclic Graph of the associations between driving time and mammography facility density within residential neighborhood, and frequency of mammography screening use
Figure 2
Figure 2
Estimated spatial pattern of average annual mammography utilization in Wisconsin relative to location of mammography facilities (black points) (N=5,930), Wisconsin Women’s Health Study, 1995–2007
See this image and copyright information in PMC

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