2023-09-28 14:46:10 +00:00
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abstract: 'BACKGROUND: Rural US women experience disparities in breast cancer
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screening and outcomes. In 2006, a national rural health insurance
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provider, the National Rural Electric Cooperative Association (NRECA),
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eliminated out-of-pocket costs for screening mammography. METHODS: This
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study evaluated the elimination of cost sharing as a natural experiment:
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it compared trends in screening before and after the policy change.
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NRECA insurance claims data were used to identify all women aged 40 to
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64 years who were eligible for breast cancer screening, and mammography
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utilization from 1998 through 2011 was evaluated. Repeated measures
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regression models were used to evaluate changes in utilization over time
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and the association between screening and sociodemographic factors.
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RESULTS: The analysis was based on 45,738 women enrolled in the NRECA
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membership database for an average of 6.1 years and included 279,940
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person-years of enrollment. Between 1998 and 2011, the annual screening
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rate increased from 35\% to a peak of 50\% among women aged 40 to 49
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years and from 49\% to 58\% among women aged 50 to 64 years. The
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biennial screening rate increased from 56\% to 66\% for women aged 40 to
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49 years and from 68\% to 73\% for women aged 50 to 64 years. Screening
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rates increased significantly (P < .0001) after the elimination of cost
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sharing and then declined slightly after changes to government screening
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guidelines in 2009. Younger women experienced greater increases in both
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annual screening (6.2\%) and biennial screening (5.6\%) after the
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elimination of cost sharing in comparison with older women (3.0\% and
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2.6\%, respectively). In a multivariate analysis, rural residence, lower
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population income, and lower population education were associated with
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modestly lower screening. CONCLUSIONS: In a national sample of
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predominantly rural working-age women, the elimination of cost sharing
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correlated with increased breast cancer screening. (C) 2017 American
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Cancer Society.'
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affiliation: 'Peppercorn, J (Corresponding Author), Massachusetts Gen Hosp, Canc Survivorship
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Program, 55 Fruit St, Boston, MA 02114 USA.
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Peppercorn, Jeffrey; Horick, Nora; Rabin, Julia, Massachusetts Gen Hosp, Ctr Canc,
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Boston, MA USA.
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Houck, Kevin, Duke Univ, Med Ctr, Durham, NC USA.
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Villagra, Victor, Univ Connecticut, Hlth Ctr, Farmington, CT USA.
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Lyman, Gary H., Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104
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USA.
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Wheeler, Stephanie B., Univ N Carolina, Sch Global Publ Hlth, Chapel Hill, NC USA.'
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author: Peppercorn, Jeffrey and Horick, Nora and Houck, Kevin and Rabin, Julia and
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Villagra, Victor and Lyman, Gary H. and Wheeler, Stephanie B.
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author-email: jpeppercorn@mgh.harvard.edu
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author_list:
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- family: Peppercorn
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given: Jeffrey
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- family: Horick
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given: Nora
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- family: Houck
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given: Kevin
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- family: Rabin
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given: Julia
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- family: Villagra
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given: Victor
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- family: Lyman
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given: Gary H.
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- family: Wheeler
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given: Stephanie B.
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da: '2023-09-28'
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doi: 10.1002/cncr.30629
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eissn: 1097-0142
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files: []
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issn: 0008-543X
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journal: CANCER
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keywords: 'access to care; breast cancer screening; disparities; health policy;
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rural health'
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keywords-plus: UNITED-STATES; TRENDS; RATES
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language: English
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month: JUL 1
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number: '13'
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number-of-cited-references: '26'
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orcid-numbers: 'Lyman, Gary H/0000-0002-0823-8086
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Horick, Nora/0000-0002-4355-5853'
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pages: 2506-2515
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papis_id: 5b79a2f7a6bba0c650096f49e1837175
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ref: Peppercorn2017impactelimination
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researcherid-numbers: 'Peppercorn, Jeffrey/GPX-3100-2022
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Lyman, Gary H/K-5227-2019
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'
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times-cited: '8'
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title: 'Impact of the Elimination of Cost Sharing for Mammographic Breast Cancer Screening
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Among Rural US Women: A Natural Experiment'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000403469500019
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usage-count-last-180-days: '0'
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usage-count-since-2013: '4'
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volume: '123'
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web-of-science-categories: Oncology
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year: '2017'
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