Brief report
Mental Illness and Use of Screening Mammography Among Medicaid Beneficiaries

https://doi.org/10.1016/j.amepre.2012.03.002Get rights and content

Background

Disparities in receipt of preventive services by people with mental illness have been documented previously. However, whether these disparities extend to screening mammography among individuals experiencing comparable barriers to accessing care has not been examined fully.

Purpose

To determine whether disparities exist in receipt of screening mammography between women with and without mental illness enrolled in Medicaid, a program with documented potential to reduce healthcare disparities.

Methods

Receipt of screening mammography was examined among women aged 50–64 years enrolled in Ohio's Medicaid program during the years 2002–2008 (n=130,088). Receipt of annual screening mammography was examined among those with at least one screening mammography during the study period. Mental illness was identified through diagnostic, service, and pharmacotherapy codes (n=61,661).

Results

Compared to women without mental illness, more women with mental illness received at least one screening mammography during the study period (31.7% vs 38.1%, p<0.001). However, after adjusting for potential confounders, including the presence of comorbid conditions and length of enrollment in Medicaid, women with mental illness were 32% less likely to undergo at least one screening mammography (AOR=0.68, 95% CI=0.66, 0.70). Among those who received at least one screening mammography, fewer women with mental illness received screening mammography on an annual basis (5.9% vs 12.7%, p<0.001; AOR=0.53, 95% CI=0.49, 0.56). For all beneficiaries, each year of enrollment in Medicaid increased the likelihood of screening mammography use by at least 50%.

Conclusions

Medicaid beneficiaries with mental illness constitute a particularly vulnerable population for suboptimal breast cancer screening.

Section snippets

Data Sources

The Ohio Medicaid enrollment and claims files for the years 2002–2008 were used. The study population was identified from the enrollment file, and screening mammography was identified from claims data by using diagnosis and procedure codes.

The current study was approved by the Case Western Reserve University Cancer IRB, as well as the Ohio Department of Job and Family Services, which administers the Medicaid program.

Study Population

The study population included all women aged 50–64 years and enrolled in

Results

Table 1 summarizes relevant demographic and health characteristics of the study population, stratified by mental illness. Just under half of the study population was identified with mental illness. Compared to those without mental illness, women with mental illness were more likely to be non–African-American, reside in an Appalachian county, bear medical comorbidities, and be enrolled in Medicaid for longer periods.

The unadjusted proportion of women with and without mental illness receiving at

Discussion

Medicaid beneficiaries with mental illness experience significant disadvantage in breast cancer screening, whether measured by receipt of at least one screening mammography or by the recommended frequency of annual screening. As a comparison, the 2005 National Health Interview Survey (NHIS) documented that nearly 72% of women in the group aged 50–64 years received a mammogram in the prior 2 years.18 Based on the findings from the present study and that of the aforementioned NHIS study, it was

References (18)

There are more references available in the full text version of this article.

Cited by (30)

  • Health Care Disparities in Radiology—A Review of the Current Literature

    2022, Journal of the American College of Radiology
    Citation Excerpt :

    One study showed that after the Affordable Care Act was implemented, there was a trend toward more non-White patients and urban residents accessing breast cancer care [48]. Another vulnerable group, those with mental illness, were actually demonstrated to access mammography more than their non–mentally ill counterparts, unless they were Medicaid beneficiaries, in which case they experienced significant disadvantages in breast cancer screening [49]. These studies demonstrate how a lack of insurance, or in contrast, adequate insurance, can result in significant barriers to access of mammographic services.

  • How does familiarity impact the stigma of mental illness?

    2019, Clinical Psychology Review
    Citation Excerpt :

    Research suggests, however, that stigma among primary care providers contributes to lower quality of care in this population (Thornicroft, 2013). Compared with patients not identified with mental illness, studies have shown that health providers are less likely to refer patients with mental illness for mammography (Koroukian, Bakaki, Golchin, Tyler, & Loue, 2012), inpatient hospitalization after diabetic crisis (Sullivan, Han, Moore, & Kotrla, 2006), prescription practices for arthritis (Corrigan, Mittal, et al., 2014), or cardiac catheterization (Druss, Bradford, Rosenheck, Radford, & Krumholz, 2000). In a classic paper, Cohen and Cohen (1984) explained the stigma of providers in terms of the clinician's illusion.

  • Mammography usage with relevant factors among women with mental disabilities in Taiwan: A nationwide population-based study

    2015, Research in Developmental Disabilities
    Citation Excerpt :

    Results from past studies have not been entirely consistent with respect to the use of screening mammography among individuals with mental illness. Research conducted by Koroukian, Bakaki, Golchin, Tyler, and Loue (2012) in Ohio State, United States, showed a higher rate of mammographic breast cancer screening for women with than without mental illness (38.1% vs. 31.7%). Another study in New Mexico State by Yee et al. (2011) found that women with mental illness were less likely than those without such illness (odds ratio [OR], 0.79) to undergo breast cancer screening.

  • Mental health stigma and primary health care decisions

    2014, Psychiatry Research
    Citation Excerpt :

    However, research also suggests that some provider decisions may worsen health outcomes. Compared to patients not identified with mental illness, research has shown health providers are less likely to refer patients with mental illness for mammography (Koroukian et al., 2012), inpatient hospitalization after diabetic crisis (Sullivan et al., 2006), or cardiac catheterization (Druss et al., 2000). Provider endorsement of stigma might be one influence on these health care decisions for people with mental illness (Jones et al., 2008; Thornicroft et al., 2007).

View all citing articles on Scopus
View full text