Associations between insurance status, financial hardship, and rurality on receipt of guideline-concordant mammography

Varying mammography guidelines can serve as a barrier to care. It is unknown how financial hardship, insurance, and rurality are associated with mammography receipt. This cross-sectional study used 2023 National Health Interview Survey data. Outcomes included receipt of an American Cancer Society (ACS) or US Preventive Services Task Force (USPSTF) guideline-concordant mammogram. Exposures included report of healthcare-related financial hardship (HRFH), insurance status, and rurality. We estimated odds ratios (OR) and 95% confidence intervals (CI) to assess the interaction between 1) HRFH and insurance status and 2) HRFH and rurality on receipt of an ACS or USPSTF mammogram. A total of 11,138 women were included who were eligible to receive a mammogram based on USPSTF guidelines. Mean age was 51 years, 61% were non-Hispanic White, 10% lived in poverty, & 19% had not received a USPSTF guideline-concordant mammogram. We found that among insured individuals, those who did vs did not report HRFH had lower odds of receipt of a USPSTF concordant mammogram (OR 0.68, 95% CI 0.58-0.80). Additionally, we found that among urban residents, those who did vs did not report HRFH had lower odds of receipt of an USPSTF concordant mammogram (OR 0.68, 95% CI 0.58-0.79). Results were similar assessing the receipt of an ACS guideline-concordant mammogram. Financial hardship is a barrier to mammography regardless of insurance status and rural residence. Programs that address financial barriers to cancer screening beyond insurance and rural access are needed.