Individual Characteristics Associated with Receipt of Breast and Cervical Screening Services Among Women Enrolled in the Kansas National Breast and Cervical Cancer Early Detection Program (KS-NBCCEDP) *

BACKGROUND:   KS-NBCCEDP is a federally funded breast and cervical cancer screening program that provides free screening and diagnostic services to Kansas women ages 40-64, under 225% of poverty and uninsured.  The program enrolls approximately 7,800 eligible women each year. Across the state, nearly 1 in 4 women who enroll do not follow through to at least one service.  This analysis seeks to identify the individual characteristics of enrolled women who follow through to services compared to those who do not. Study findings aim to deepen our understanding of the women we serve and identify areas for intervention.

METHODS:   KS-NBCCEDP enrollment and service use data are maintained in Catalyst, a cloud-based data management system.  A data set containing 7,270 unique patient records were extracted from Catalyst for the time period July 1, 2013 through June 30, 2014 for Kansas women meeting eligibility requirements. Least squares means and crude and adjusted odds ratios were computed using SAS/STAT version 9.3 software to compare women enrolled in KS-NBCCEDP who subsequently received services paid for by KS-NBCCEDP (“follow-through”) to those who did not. Statistical significance was indicated at the α<.05 level. Individual characteristics assessed include age, race/ethnicity, population density, prior KS-NBCCEDP services, presence of breast symptoms, prior receipt of a mammogram or PAP test, referral source, number of household members, and drive time to provider. Drive time to provider was computed using the ArcGIS Network Analyst tool.

RESULTS:   The odds of follow-through were significantly lower among first time enrolled women vs. women who historically received 3 or more KS-NBCCEDP services (OR= 0.47; 95% CI: 0.41-0.55); women living in urban vs. rural counties (OR=0.55; 95% CI: 0.41-0.74); and black (0.55; 95% CI: 0.45-0.66) or Hispanic (0.76; 95% CI: 0.67-.87) vs. white women.  After controlling for potential confounders, the odds of follow-through remained significantly lower for first time enrolled women (aOR=0.47, 95% CI= 0.41-0.54), black women (aOR=0.62, 95% CI: 0.51-0.76) and Hispanic women (aOR=0.76; 95% CI= 0.67-0.88). Follow-through did not differ significantly by presence of breast symptoms, prior mammogram or Pap screenings, drive time to provider, or age.

CONCLUSIONS:   Black and Hispanic women, women enrolling from urban areas, and women enrolling for the first time in the KS-NBCCEDP program may need additional interventions to successfully engage in services. Multivariate regression and hierarchical regression analyses examining differences in provider-level characteristics of women who follow through to services versus those who do not are currently underway.