Do large cities face disparities in mammography utilization?

New research published in Radiology found that screening mammography use is highest in coastal cities, while cities within mountain states are lagging behind.

Eric Kim, MD, with New York University Langone Health’s Department of Radiology and colleagues pointed out that most studies have focused on rural disparities when examining the use of screening mammography, and for good reason, but not much is known about city-level variation.

“Previous studies have tended to focus on these rural disparities in screening or have evaluated screening in local urban environments,” the researchers wrote. “To our knowledge, no previous study has looked at screening mammography utilization specifically at the city level throughout the entire country even though more than 30 million adult women live in the 500 largest cities of the United States.”

Kim and colleagues retrospectively collected data from two publicly available resources: the American Community Survey and Robert Wood Johnson Foundation 500 Cities Project—a collaboration with the CDC Foundation that includes healthcare data from 497 of the United States’ largest cities and accounting for 33.4% of the country’s total population.

Overall, mean city-level screening mammography utilization was 77.7%. The highest number was seen in coastal cities, particularly in the New England area (82.7%). The lowest rates were seen in mountain states (73.6%).

Newton, Mass. achieved the highest rates (88.9%) while Nampa, Idaho came in at the lowest (62.8%).

“Our study demonstrates that disparities in health care preventive service utilization are not solely a function of rural versus urban provider resources and geographic remoteness, which is often the focus of the disparity, but also must be considered at the large city level,” the researchers wrote. “This disparity is especially important to recognize given that more than 30 million women live in the largest cities in the United States.”

Additionally, the team found that the four strongest predictors of mammography screening use were” census division, percentage of people up to date with a Papanicolaou test, of Asian race and those with private insurance.

“The identification of predictors of uptake and recognition of the importance of linking breast cancer screening to other preventive services may help target cities and populations for screening education and intervention, with the ultimate goal of improving mortality from breast cancer.”