Haynes David, Hughes Kelly D, Borerro Maria, Haas McKenna, Roach Lauren, Blaes Anne
University of Minnesota.
Minnesota Department of Health.
Res Sq. 2023 May 16:rs.3.rs-2886477. doi: 10.21203/rs.3.rs-2886477/v1.
The mission of the National Breast and Cervical Cancer Early Detection Program's (NBCCEDP) mission is to improve access to mammography and other health services for underserved women. Since its inception in 1991, this national program has improved breast cancer screening rates for women who are uninsured and underinsured. However, the literature has shown that NBCCEDP screenings are decreasing, and only reach a portion of eligible women. Reliable estimates at the sub-county level are needed to identify and reach eligible women. Our work builds upon previous estimates by integrating uninsured and insurance status into spatially adaptive filters. We use spatially adaptive filters to create small area estimates of standardized incidence ratios describing the utilization rate of NBCCEDP services in Minnesota. We integrate the American Community Survey (2010-2014) insurance status data to account for the percentage that an individual is uninsured. We test five models that integrate insurance status by age, sex, and race/ethnicity. Our composite model, which adjusts for age, sex, and race/ethnicity insurance statuses, reduces 95% of the estimation error. We estimate that there approximately 49,913.7 women eligible to receive services for Minnesota. We also create small geography (i.e., county and sub-county) estimates for Minnesota. The integration of the insurance data improved our utilization estimate. The development of these methods will allow state programs to more efficiently use their resources and understand their reach.
国家乳腺癌和宫颈癌早期检测项目（NBCCEDP）的使命是改善为服务不足的女性提供乳房X光检查和其他医疗服务的可及性。自1991年启动以来，这个国家级项目提高了未参保和保险不足女性的乳腺癌筛查率。然而，文献表明NBCCEDP筛查正在减少，且仅覆盖了一部分符合条件的女性。需要在县以下层面进行可靠估计，以识别并覆盖符合条件的女性。我们的工作基于先前的估计，将未参保和保险状况纳入空间自适应滤波器。我们使用空间自适应滤波器来创建标准化发病率比的小区域估计值，以描述明尼苏达州NBCCEDP服务的利用率。我们整合了美国社区调查（2010 - 2014年）的保险状况数据，以计算个人未参保的百分比。我们测试了五个按年龄、性别和种族/族裔整合保险状况的模型。我们的综合模型对年龄、性别和种族/族裔保险状况进行了调整，减少了95%的估计误差。我们估计明尼苏达州约有49,913.7名女性有资格接受服务。我们还为明尼苏达州创建了小地理区域（即县和县以下区域）的估计值。保险数据的整合改进了我们对利用率 的估计。这些方法的开发将使州项目能够更有效地利用其资源并了解其覆盖范围。
