Breast Cancer Screening Rates Among Medicaid Beneficiaries With Schizophrenia

Abstract

Objective: Women with serious mental illness are more likely to be diagnosed as having late-stage breast cancer than women without serious mental illness, suggesting a disparity in screening mammography. This study aimed to compare screening mammography rates in a nationally representative sample of Medicaid beneficiaries with and without schizophrenia.

Methods: Medicaid Analytic eXtract files, 2007-2012, were used to identify a cohort of women ages 40-64 with schizophrenia who were eligible for Medicaid but not Medicare (N=87,572 in 2007 and N=114,341 in 2012) and a cohort without schizophrenia, frequency-matched by age, race-ethnicity, and state (N=97,003 in 2007 and N=126,461 in 2012). Annual screening mammography rates were calculated and adjusted for demographic characteristics and comorbid conditions. Multivariable logistic regression was used to estimate the association between beneficiary characteristics and screening mammography rates.

Results: In 2012, 27.2% of women with schizophrenia completed screening mammography, compared with 26.8% of the control cohort. In the schizophrenia cohort, American Indian/Alaskan Native women had significantly lower odds of receiving mammography (OR=0.82, p=0.02) than White women, whereas Hispanic/Latina women had higher odds (OR=1.16, p<0.001). Women with schizophrenia and a nonalcohol-related substance use disorder had lower odds of receiving mammography (OR=0.74, p<0.001) than women without a substance use disorder. Having at least one medical visit in the past year (vs. no visits) increased the odds of receiving screening mammography (OR=5.08, p<0.001).

Conclusions: Screening mammography rates were similar between Medicaid-insured women with and those without schizophrenia. Interventions to increase uptake may need to focus on improving socioeconomic conditions and primary care engagement for vulnerable populations, regardless of psychiatric condition.

Keywords: Cancer; Mammography; Prevention; Primary care; Schizophrenia; Women.

FIGURE 1.. Screening mammography rates for women with schizophrenia and a frequency-matched control cohort, 2007–2012^a

^a Unadjusted annual mammography rate was defined as at least one claim for screening mammography in a given year per non–dually eligible Medicaid beneficiary, divided by the number of non–dually eligible beneficiaries.

FIGURE 2.. Screening mammography among women with schizophrenia, by demographic characteristics, comorbid conditions, and health care utilization, 2012^a

^a Multivariable logistic regression with robust standard errors was used to estimate associations between patient characteristics and the likelihood of receiving screening mammography; values on the x-axis denote ORs. ^b OR = 5.08, 95% CI = 4.84–5.33.

FIGURE 3.. Screening mammography rates for women with schizophrenia, by state^a

^a Shading indicates the percentage of non–dually eligible Medicaid beneficiaries with schizophrenia in the state who received at least one screening mammography in 2012 (N = 31,061). Screening rates were adjusted for age, race-ethnicity, and comorbid conditions. Data were unavailable for states shown in white.