Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography

Citation

Durham, Danielle D.; Robinson, Whitney R.; Lee, Sheila S.; Wheeler, Stephanie B.; Reeder-Hayes, Katherine E.; Bowling, J. Michael; Olshan, Andrew F.; & Henderson, Louise M. (2016). Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography. Cancer Epidemiology, Biomarkers & Prevention, 25(11), 1474-1482. PMCID: PMC5115635

Abstract

BACKGROUND: Insurance may lengthen or inhibit time to follow-up after positive screening mammography. We assessed the association between insurance status and time to initial diagnostic follow-up after a positive screening mammogram.
METHODS: Using 1995-2010 data from a North Carolina population-based registry of breast imaging and cancer outcomes, we identified women with a positive screening mammogram. We compared receipt of follow-up within 60 days of screening using logistic regression and evaluated time to follow-up initiation using Cox proportional hazards regression.
RESULTS: Among 43,026 women included in the study, 73% were <65 years and 27% were 65+ years. Median time until initial diagnostic follow-up was similar by age group and insurance status. In the adjusted model for women <65, uninsured women experienced a longer time to initiation of diagnostic follow-up [HR, 0.47; 95% confidence interval (CI), 0.25-0.89] versus women with private insurance. There were increased odds of these uninsured women not meeting the Centers for Disease Control and Prevention guideline for follow-up within 60 days (OR, 1.59; 95% CI, 1.31-1.94). Among women ages 65+, women with private insurance experienced a faster time to follow-up (adjusted HR, 2.09; 95% CI, 1.27-3.44) than women with Medicare and private insurance. Approximately 10% of women had no follow-up by 365 days.
CONCLUSIONS: We found differences in time to initial diagnostic follow-up after a positive screening mammogram by insurance status and age group. Uninsured women younger than 65 years at a positive screening event had delayed follow-up.
IMPACT: Replication of these findings and examination of their clinical significance warrant additional investigation.

URL

http://dx.doi.org/10.1158/1055-9965.epi-16-0148

Reference Type

Journal Article

Year Published

2016

Journal Title

Cancer Epidemiology, Biomarkers & Prevention

Author(s)

Durham, Danielle D.
Robinson, Whitney R.
Lee, Sheila S.
Wheeler, Stephanie B.
Reeder-Hayes, Katherine E.
Bowling, J. Michael
Olshan, Andrew F.
Henderson, Louise M.

PMCID

PMC5115635

ORCiD

Robinson, W - 0000-0003-4009-0488