Person:

Xu, Xin

Purpose In November 2009, the US Preventive Services Task Force (USPSTF) changed its mammography recommendations from every 1 to 2 years among women age ≥ 40 years to personalized screening decisions for women age 40 to 49 years and screening every 2 years for women age 50 to 74 years.

Methods We studied mammography trends among 5.5 million women age 40 to 64 years enrolled in a large national health insurer. We used 2005 to 2009 mammography trends to predict 2012 rates. Our primary measure was the estimated difference between observed and predicted 2012 annual and biennial mammography rates. We stratified results by age group and race/ethnicity.

Results Among women age 40 to 49 years, 2012 mammography rates declined by 9.9% (95% CI, −10.4% to −9.3%) relative to the predicted 2012 rate. Decreases were lowest among black women (−2.3%; 95% CI, −6.3% to 1.8%) and highest among Asian women (−17.4; 95% CI, −20.0 to −14.8). Annual mammography rates among women age 50 to 64 years declined by 6.1% (95% CI, −6.5% to −5.7%) by 2012. Regarding biennial mammography rates, women age 40 to 49 years experienced a 9.0% relative reduction (95% CI, −9.6% to −8.4%). White, Hispanic, and Asian women age 40 to 49 years demonstrated similar relative reductions of approximately 9% to 11%, whereas black women had no detectable changes (0.1%; 95% CI, −4.0% to 4.3%). Women age 50 to 64 years had a 6.2% relative reduction (95% CI, −6.6% to −5.7%) in biennial mammography that was similar among white, Hispanic, and Asian women. Black women age 50 to 64 years did not have changes in biennial mammography (0.4%; 95% CI, −2.6% to 3.5%).

Conclusion Three years after publication of the 2009 USPSTF guidelines, mammography rates declined by 6% to 17% among white, Hispanic, and Asian women but not among black women. Small reductions in biennial mammography might be an unintended consequence of the updated guidelines.

Background: Little is known about the long-term effects of high-deductible insurance on care for chronic medical conditions.
Objective: To determine whether a transition from low-deductible to high-deductible insurance is associated with delays in the medical care for macrovascular complications of diabetes. Design: Observational comparison of matched groups. Setting: A large national health insurer during 2003-2012.
Participants: The intervention group included 33,957 enrollees with diabetes who were continuously enrolled in low-deductible (<USD500) insurance plans during a baseline year followed by up to 4 years in high-deductible (≥USD1000) plans. The control group included 294,942 enrollees with diabetes who were in low-deductible plans and whose enrollment was contemporaneous with matched intervention group members. Intervention: Employer-mandated transition to a high-deductible insurance plan. Measurements: We determined how long it took for enrollees in each study group to seek care for their first major macrovascular symptom, to have their first major diagnostic test for macrovascular disease, and to have their first major procedure-based treatment. We then calculated the differences in months for the study groups to reach a midpoint event rate. Results: We did not find baseline differences between study groups. During follow-up, the delay for the high-deductible group was 1.5 months (95% CI: 0.8, 2.3) to first major symptom, 1.9 months (1.4, 2.3) to first major diagnostic test, and 3.1 (0.5, 5.8) months to first procedure-based treatment.
Limitation: The study did not examine health outcomes. Conclusion: Among enrollees with diabetes, mandated enrollment in a high-deductible insurance plan was associated with delays in seeking care for first major symptoms of macrovascular disease, first diagnostic testing, and first procedure-based treatment. Primary Funding Source: This work was supported by grant R01DK100304 from the National Institute of Diabetes and Digestive and Kidney Diseases.