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Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study

Published: April 11, 2014
Category: Papers
Authors: Austin PC, Booth GL, Chan W, Hux J, Jaakkimainen RL, Lipscombe LL, Rochon PA, Yun L
Country: Canada
Language: null
Type: Population Health
Settings: Hospital, PCP

Diabet Med 31:806-812.

Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

AIMS: There is evidence to suggest that mammography rates are decreased in women with diabetes and in women of lower socio-economic status. Given the strong association between low socio-economic status and diabetes, we explored the extent to which differences in socio-economic status explain lower mammography rates in women with diabetes.

METHODS: A population-based retrospective cohort study in Ontario, Canada, of women aged 50 to 69 years with diabetes between 1999 and 2010 age matched 1:2 to women without diabetes. Main outcome measure is the likelihood of at least one screening mammogram in women with diabetes within a 36-month period, starting as of either 1 January 1999, their 50th birthday, or 2 years after diabetes diagnosis–whichever came last. Outcomes were compared with those in women without diabetes during the same period as their matched counterparts, adjusting for socio-economic status based on neighbourhood income and other demographic and clinical variables.

RESULTS: Of 504,288 women studied (188,759 with diabetes, 315,529 with no diabetes), 63.8% had a screening mammogram. Women with diabetes were significantly less likely to have a mammogram after adjustment for socio-economic status and other factors (odds ratio 0.79, 95% CI 0.78-0.80). Diabetes was associated with lower mammogram use even in women from the highest socio-economic status quintile (odds ratio 0.79, 95% CI 0.75-0.83).

CONCLUSIONS: The presence of diabetes was an independent barrier to breast cancer screening, which was not explained by differences in socio-economic status. Interventions that target patient, provider, and health system factors are needed to improve cancer screening in this population.

PMID: 24588332

Canada,Population Markers,High Impact Chronic Conditions,Gender,Co-morbidity,Aged,Breast Neoplasms/economics,Cohort Studies,Diabetes Mellitus/economics,Early Detection of Cancer/economics,Follow-Up Studies,Health Services Accessibility/economics,Health Status Disparities,Mammography/economics,Mass Screening/economics,Middle Aged,Odds Ratio,Ontario/epidemiology,Retrospective Studies,Socioeconomic Factors

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