Housing-Related Disparities in Receipt of Breast Cancer Screening Among Women Medicaid Beneficiaries.

Abstract

Purpose: People experiencing housing insecurity (PEHI) may face barriers to preventive cancer screening, but the extent to which PEHI receive screening at the population level is understudied. Therefore, this study examined disparities in utilization of breast cancer screening associated with housing insecurity (HI) among women beneficiaries enrolled in a large Medicaid program.

Methods: We assessed receipt of biennial mammography among women Medicaid beneficiaries, age 50-64 years, in administrative Medicaid data linked to encounter-level records on housing-related services in Pennsylvania (PA; Homelessness Management Information System [HMIS]) from 2011 to 2019. We characterized disparities in screening between beneficiaries with an encounter for housing-related services in HMIS (indicating experience or history of HI) compared with beneficiaries without any such encounters.

Results: We included 73,456 women Medicaid beneficiaries in PA, including 1,792 HMIS service recipients and 71,664 comparison beneficiaries. The mammography rate was 44.8% among HMIS service recipients and 50.1% among comparison beneficiaries, representing a disparity of 5.3 percentage-points (pp; P < .001). This disparity was pronounced between HMIS service recipients with chronic experience of homelessness and comparison beneficiaries (-9.4 pp; P = .036). In stratified analyses, beneficiaries without any primary care visits had the lowest rate of mammography, although realized access to primary care did not eliminate the disparity in screening associated with HI.

Conclusion: HI was associated with a significant disparity in mammography among women Medicaid beneficiaries, underscoring the need for efforts to improve preventive care among housing-insecure populations.