Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: A natural experiment

Jeffrey Peppercorn, Nora Horick, Kevin Houck, Julia Rabin, Victor Villagra, Gary H. Lyman, Stephanie B. Wheeler

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Rural US women experience disparities in breast cancer screening and outcomes. In 2006, a national rural health insurance provider, the National Rural Electric Cooperative Association (NRECA), eliminated out-of-pocket costs for screening mammography. METHODS: This study evaluated the elimination of cost sharing as a natural experiment: it compared trends in screening before and after the policy change. NRECA insurance claims data were used to identify all women aged 40 to 64 years who were eligible for breast cancer screening, and mammography utilization from 1998 through 2011 was evaluated. Repeated measures regression models were used to evaluate changes in utilization over time and the association between screening and sociodemographic factors. RESULTS: The analysis was based on 45,738 women enrolled in the NRECA membership database for an average of 6.1 years and included 279,940 person-years of enrollment. Between 1998 and 2011, the annual screening rate increased from 35% to a peak of 50% among women aged 40 to 49 years and from 49% to 58% among women aged 50 to 64 years. The biennial screening rate increased from 56% to 66% for women aged 40 to 49 years and from 68% to 73% for women aged 50 to 64 years. Screening rates increased significantly (P <.0001) after the elimination of cost sharing and then declined slightly after changes to government screening guidelines in 2009. Younger women experienced greater increases in both annual screening (6.2%) and biennial screening (5.6%) after the elimination of cost sharing in comparison with older women (3.0% and 2.6%, respectively). In a multivariate analysis, rural residence, lower population income, and lower population education were associated with modestly lower screening. CONCLUSIONS: In a national sample of predominantly rural working-age women, the elimination of cost sharing correlated with increased breast cancer screening. Cancer 2017;123:2506–15.

LanguageEnglish (US)
Pages2506-2515
Number of pages10
JournalCancer
Volume123
Issue number13
DOIs
StatePublished - Jul 1 2017

Fingerprint

Cost Sharing
Early Detection of Cancer
Breast Neoplasms
Mammography
Working Women
Rural Health
National Health Programs
Health Expenditures
Insurance
Population
Multivariate Analysis
Databases
Guidelines
Education

Keywords

  • access to care
  • breast cancer screening
  • disparities
  • health policy
  • rural health

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Peppercorn, J., Horick, N., Houck, K., Rabin, J., Villagra, V., Lyman, G. H., & Wheeler, S. B. (2017). Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: A natural experiment. Cancer, 123(13), 2506-2515. DOI: 10.1002/cncr.30629

Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women : A natural experiment. / Peppercorn, Jeffrey; Horick, Nora; Houck, Kevin; Rabin, Julia; Villagra, Victor; Lyman, Gary H.; Wheeler, Stephanie B.

In: Cancer, Vol. 123, No. 13, 01.07.2017, p. 2506-2515.

Research output: Contribution to journalArticle

Peppercorn, J, Horick, N, Houck, K, Rabin, J, Villagra, V, Lyman, GH & Wheeler, SB 2017, 'Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: A natural experiment' Cancer, vol 123, no. 13, pp. 2506-2515. DOI: 10.1002/cncr.30629
Peppercorn J, Horick N, Houck K, Rabin J, Villagra V, Lyman GH et al. Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: A natural experiment. Cancer. 2017 Jul 1;123(13):2506-2515. Available from, DOI: 10.1002/cncr.30629
Peppercorn, Jeffrey ; Horick, Nora ; Houck, Kevin ; Rabin, Julia ; Villagra, Victor ; Lyman, Gary H. ; Wheeler, Stephanie B./ Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women : A natural experiment. In: Cancer. 2017 ; Vol. 123, No. 13. pp. 2506-2515
@article{35933b7ae8594ffcb2239c94f1051e17,
title = "Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: A natural experiment",
abstract = "BACKGROUND: Rural US women experience disparities in breast cancer screening and outcomes. In 2006, a national rural health insurance provider, the National Rural Electric Cooperative Association (NRECA), eliminated out-of-pocket costs for screening mammography. METHODS: This study evaluated the elimination of cost sharing as a natural experiment: it compared trends in screening before and after the policy change. NRECA insurance claims data were used to identify all women aged 40 to 64 years who were eligible for breast cancer screening, and mammography utilization from 1998 through 2011 was evaluated. Repeated measures regression models were used to evaluate changes in utilization over time and the association between screening and sociodemographic factors. RESULTS: The analysis was based on 45,738 women enrolled in the NRECA membership database for an average of 6.1 years and included 279,940 person-years of enrollment. Between 1998 and 2011, the annual screening rate increased from 35\{%} to a peak of 50\{%} among women aged 40 to 49 years and from 49\{%} to 58\{%} among women aged 50 to 64 years. The biennial screening rate increased from 56\{%} to 66\{%} for women aged 40 to 49 years and from 68\{%} to 73\{%} for women aged 50 to 64 years. Screening rates increased significantly (P <.0001) after the elimination of cost sharing and then declined slightly after changes to government screening guidelines in 2009. Younger women experienced greater increases in both annual screening (6.2\{%}) and biennial screening (5.6\{%}) after the elimination of cost sharing in comparison with older women (3.0\{%} and 2.6\{%}, respectively). In a multivariate analysis, rural residence, lower population income, and lower population education were associated with modestly lower screening. CONCLUSIONS: In a national sample of predominantly rural working-age women, the elimination of cost sharing correlated with increased breast cancer screening. Cancer 2017;123:2506–15.",
keywords = "access to care, breast cancer screening, disparities, health policy, rural health",
author = "Jeffrey Peppercorn and Nora Horick and Kevin Houck and Julia Rabin and Victor Villagra and Lyman, {Gary H.} and Wheeler, {Stephanie B.}",
year = "2017",
month = "7",
day = "1",
doi = "10.1002/cncr.30629",
language = "English (US)",
volume = "123",
pages = "2506--2515",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "13",

}

TY - JOUR

T1 - Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women

T2 - Cancer

AU - Peppercorn,Jeffrey

AU - Horick,Nora

AU - Houck,Kevin

AU - Rabin,Julia

AU - Villagra,Victor

AU - Lyman,Gary H.

AU - Wheeler,Stephanie B.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - BACKGROUND: Rural US women experience disparities in breast cancer screening and outcomes. In 2006, a national rural health insurance provider, the National Rural Electric Cooperative Association (NRECA), eliminated out-of-pocket costs for screening mammography. METHODS: This study evaluated the elimination of cost sharing as a natural experiment: it compared trends in screening before and after the policy change. NRECA insurance claims data were used to identify all women aged 40 to 64 years who were eligible for breast cancer screening, and mammography utilization from 1998 through 2011 was evaluated. Repeated measures regression models were used to evaluate changes in utilization over time and the association between screening and sociodemographic factors. RESULTS: The analysis was based on 45,738 women enrolled in the NRECA membership database for an average of 6.1 years and included 279,940 person-years of enrollment. Between 1998 and 2011, the annual screening rate increased from 35% to a peak of 50% among women aged 40 to 49 years and from 49% to 58% among women aged 50 to 64 years. The biennial screening rate increased from 56% to 66% for women aged 40 to 49 years and from 68% to 73% for women aged 50 to 64 years. Screening rates increased significantly (P <.0001) after the elimination of cost sharing and then declined slightly after changes to government screening guidelines in 2009. Younger women experienced greater increases in both annual screening (6.2%) and biennial screening (5.6%) after the elimination of cost sharing in comparison with older women (3.0% and 2.6%, respectively). In a multivariate analysis, rural residence, lower population income, and lower population education were associated with modestly lower screening. CONCLUSIONS: In a national sample of predominantly rural working-age women, the elimination of cost sharing correlated with increased breast cancer screening. Cancer 2017;123:2506–15.

AB - BACKGROUND: Rural US women experience disparities in breast cancer screening and outcomes. In 2006, a national rural health insurance provider, the National Rural Electric Cooperative Association (NRECA), eliminated out-of-pocket costs for screening mammography. METHODS: This study evaluated the elimination of cost sharing as a natural experiment: it compared trends in screening before and after the policy change. NRECA insurance claims data were used to identify all women aged 40 to 64 years who were eligible for breast cancer screening, and mammography utilization from 1998 through 2011 was evaluated. Repeated measures regression models were used to evaluate changes in utilization over time and the association between screening and sociodemographic factors. RESULTS: The analysis was based on 45,738 women enrolled in the NRECA membership database for an average of 6.1 years and included 279,940 person-years of enrollment. Between 1998 and 2011, the annual screening rate increased from 35% to a peak of 50% among women aged 40 to 49 years and from 49% to 58% among women aged 50 to 64 years. The biennial screening rate increased from 56% to 66% for women aged 40 to 49 years and from 68% to 73% for women aged 50 to 64 years. Screening rates increased significantly (P <.0001) after the elimination of cost sharing and then declined slightly after changes to government screening guidelines in 2009. Younger women experienced greater increases in both annual screening (6.2%) and biennial screening (5.6%) after the elimination of cost sharing in comparison with older women (3.0% and 2.6%, respectively). In a multivariate analysis, rural residence, lower population income, and lower population education were associated with modestly lower screening. CONCLUSIONS: In a national sample of predominantly rural working-age women, the elimination of cost sharing correlated with increased breast cancer screening. Cancer 2017;123:2506–15.

KW - access to care

KW - breast cancer screening

KW - disparities

KW - health policy

KW - rural health

UR - http://www.scopus.com/inward/record.url?scp=85013209376&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013209376&partnerID=8YFLogxK

U2 - 10.1002/cncr.30629

DO - 10.1002/cncr.30629

M3 - Article

VL - 123

SP - 2506

EP - 2515

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 13

ER -