Abstract
Background:
The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50–74 years. We aim to generate county-level prevalence estimates for mammography use to examine disparities among counties.
Materials and Methods:
We used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 111,902 women) and linked them to county-level data from the American Community Survey. We defined two outcomes: mammography within the past 2 years (current); and mammography 5 or more years ago or never (rarely or never). We poststratified the data with U.S. Census estimated county population counts, ran Monte Carlo simulations, and generated county-level estimates. We aggregated estimates to state and national levels. We validated internal consistency between our model-based and BRFSS state estimates using Spearman and Pearson correlation coefficients.
Results:
Nationally, more than three in four women [78.7% (95% confidence interval {CI}: 78.2%–79.2%)] were current with mammography, although with large variations among counties. Also, nationally, about one in nine women [11% (95% CI: 10.8%–11.3%)] rarely or never had a mammogram. County estimates for being current ranged from 60.4% in New Mexico to 86.9% in Hawaii. Rarely or never having a mammogram ranged from 6% in Connecticut to 23.0% in Alaska, and on average, almost one in eight women in all the counties. Internal consistency correlation coefficient tests were ≥0.94.
Conclusions:
Our analyses identified marked county variations in mammography use across the country among women aged 50–74 years. We generated estimates for all counties, which may be helpful for targeted outreach to increase mammography uptake.
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