Factors associated with mammography use: A side-by-side comparison of results from two national surveys

Abstract

Background: Mammography use is affected by multiple factors that may change as public health interventions are implemented. We examined two nationally representative, population-based surveys to seek consensus and identify inconsistencies in factors associated with mammography use in the entirety of the US population, and by black and white subgroups.

Methods: Self-reported mammography use in the past year was extracted for 12 639 and 169 116 women aged 40-74 years from the 2016 National Health Interview Survey (NHIS) and the 2016 Behavioral Risk Factor Surveillance System (BRFSS), respectively. We applied a random forest algorithm to identify the risk factors of mammography use and used a subset of them in multivariable survey logistic regressions to examine their associations with mammography use, reporting predictive margins and effect sizes.

Results: The weighted prevalence of past year mammography use was comparable across surveys: 54.31% overall, 54.50% in white, and 61.57% in black in NHIS and 53.24% overall, 56.97% in white, and 62.11% in black in BRFSS. Overall, mammography use was positively associated with black race, older age, higher income, and having health insurance, while negatively associated with having three or more children at home and residing in the Western region of the US. Overweight and moderate obesity were significantly associated with increased mammography use among black women (NHIS), while severe obesity was significantly associated with decreased mammography use among white women (BRFSS).

Conclusion: We found higher mammography use among black women than white women, a change in the historical trend. We also identified high parity as a risk factor for mammography use, which suggests a potential subpopulation to target with interventions aimed at increasing mammography use.

Keywords: National health interview survey; behavioral risk factor surveillance system; breast cancer screening; mammography use; predictive margins; random forest.

Figure 1

Importance ranking of top 30 factors, identified from random forest algorithm, for predicting past year mammography use from 2016 NHIS and 2016 BRFSS.Note: ,^a Number of children in the home; ^bHighest education in the family; ^cFunctional limitation: Yes (have difficulty walking 1/4 mile, climbing 10 steps, standing for 2 hours, sitting for 2 hours, stooping/bending/kneeling, reaching over head, grasping small objects, lifting/carrying 10lbs, pushing large objects, going out to events, participating in social activities, and relaxing at home without special equipment) in NHIS; Activity limitation: Yes (have serious difficulty walking or climbing stairs, dressing or bathing, doing errands alone because of a physical, mental, or emotional condition) in BRFSS