Saint Louis University School of Medicine, St. Louis, Missouri.
O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.
J Am Coll Radiol. 2024 Sep;21(9):1406-1418. doi: 10.1016/j.jacr.2024.04.028. Epub 2024 Jun 6.
The Supplemental Nutrition Assistance Program (SNAP) addresses food insecurity for low-income households, which is associated with access to care. Many US states expanded SNAP access through policies eliminating the asset test (ie, restrictions based on SNAP applicant assets) and/or broadening income eligibility. The objective of this study was to determine whether state SNAP policies were associated with the use of mammography among women eligible for breast cancer screening.
Data for income-eligible women 40 to 79 years of age were obtained from the 2006 to 2019 Behavioral Risk Factor Surveillance System. Difference-in-differences analyses were conducted to compare changes in the percentage of mammography in the past year from pre- to post-SNAP policy adoption (asset test elimination or income eligibility increase) between states that and did not adopt policies expanding SNAP eligibility.
In total, 171,684 and 294,647 income-eligible female respondents were included for the asset test elimination policy and income eligibility increase policy analyses, respectively. Mammography within 1 year was reported by 58.4%. Twenty-eight and 22 states adopted SNAP asset test elimination and income increase policies, respectively. Adoption of asset test elimination policies was associated with a 2.11 (95% confidence interval [CI], 0.07-4.15; P = .043) percentage point increase in mammography received within 1 year, particularly for nonmetropolitan residents (4.14 percentage points; 95% CI, 1.07-7.21 percentage points; P = .008), those with household incomes <$25,000 (2.82 percentage points; 95% CI, 0.68-4.97 percentage points; P = .01), and those residing in states in the South (3.08 percentage points; 95% CI, 0.17-5.99 percentage points; P = .038) or that did not expand Medicaid under the Patient Protection and Affordable Care Act (3.35 percentage points; 95% CI, 0.36-6.34; P = .028). There was no significant association between mammography and state-level policies broadening of SNAP income eligibility.
State policies eliminating asset test requirements for SNAP eligibility were associated with increased mammography among low-income women eligible for breast cancer screening, particularly for those in the lowest income bracket or residing in nonmetropolitan areas or Medicaid nonexpansion states.
补充营养援助计划（SNAP）解决了低收入家庭的粮食不安全问题，而粮食不安全问题与获得医疗保健有关。许多美国州通过取消资产测试的政策（即基于 SNAP 申请人资产的限制）和/或扩大收入资格，扩大了 SNAP 的覆盖范围。本研究的目的是确定州 SNAP 政策是否与符合乳腺癌筛查条件的女性进行乳房 X 光检查的使用有关。
从 2006 年至 2019 年的行为风险因素监测系统中获取了 40 至 79 岁符合收入条件的女性的数据。采用差异-差异分析比较了在实施 SNAP 政策（取消资产测试或增加收入资格）前后，实施和未实施扩大 SNAP 资格政策的州之间，过去一年接受乳房 X 光检查的百分比的变化。
共有 171684 名符合收入条件的女性和 294647 名符合收入条件的女性分别接受了资产测试消除政策和收入资格增加政策分析。在过去一年中有 58.4%的人接受了乳房 X 光检查。28 个和 22 个州分别通过了 SNAP 资产测试消除和收入增加政策。取消资产测试政策与接受一年内乳房 X 光检查的比例增加了 2.11 个百分点（95%置信区间 [CI]，0.07-4.15；P=.043），特别是对于非城市居民（4.14 个百分点；95%CI，1.07-7.21 个百分点；P=.008）、家庭收入<25000 美元（2.82 个百分点；95%CI，0.68-4.97 个百分点；P=.01）和居住在南部各州（3.08 个百分点；95%CI，0.17-5.99 个百分点；P=.038）或未根据《患者保护与平价医疗法案》扩大医疗补助的州（3.35 个百分点；95%CI，0.36-6.34 个百分点；P=.028）的人。州一级扩大 SNAP 收入资格的政策与接受乳房 X 光检查之间没有显著关联。
取消 SNAP 资格的资产测试要求的州政策与符合乳腺癌筛查条件的低收入妇女接受乳房 X 光检查的人数增加有关，特别是在收入最低的人群或居住在非城市地区或未扩大医疗补助的州的人群中。
