Racial disparities in mammogram rates across Texas in 2022: A statewide analysis.

Abstract

e22511 Background: Breast cancer is the second leading cause of cancer death among women in the United States, and its incidence has been steadily increasing. Survival from breast cancer depends on the stage at diagnosis, and literature indicates that sociodemographic characteristics are associated with screening rates. Examining and understanding racial disparities is crucial to improving screening rates and reducing the burden of breast cancer in underserved populations. Methods: We used the Texas Outpatient Public Use Data File (TOPUDF), a publicly available dataset, to conduct a population-based cohort study of mammograms among females aged ≥ 40 years old at hospitals and ambulatory surgery centers during 2022. Mammograms were identified using Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. We queried the US Census Bureau, Population Division for age-grouped populations in 2022 stratified by gender, race, ethnicity, age group, and county of residence. We calculated age-adjusted outpatient mammogram rates per 1,000 population (AAMRs) using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mammograms. The statistical significance of the difference between racial groups AAMR were tested by comparing the intersection of 95% confidence intervals (95% CI) for the individual rates. Subgroup analyses included age group, rural vs urban residence, and public health region. Results: The female population aged ≥ 40 years during 2022 was 6,756,811, and a total of 1,425,988 mammograms were included in the study corresponding to AAMR 198.0 (95% CI 197.7 – 198.3). Asians were 7.0% of the target population, received 12.5% of mammograms, and had the highest AAMR 356.9 (95% CI 355.2 - 358.6). Whites were 48.8% of the target population, received 51.3% of mammograms, and had the second highest AAMR 205.4 (95% CI 205.0 - 205.9). Blacks were 12.3% of the target population, received 12.3% of mammograms, and had the third highest AAMR 196.7 (95% CI 195.7 - 197.6). Hispanics were 31.8% of the target population, received 23.8% of mammograms and had the lowest AAMR 149.3 (95% CI 148.8 - 149.8). The differences between racial groups were significant. On subgroup analyses using public health regions, Hispanics had the lowest AAMR in public health regions with large metropolitan centers but had substantial high rates in far western and far southern Texas. Asians had much higher AAMR in regions with large metropolitan centers. Conclusions: Significant racial disparities in mammogram rates exist among women in Texas. Hispanic women have the lowest AAMR, particularly in urban areas. To reduce the burden of breast cancer and improve screening rates in the community, there is a need for targeted interventions among underserved populations.