Evaluation of Geographic Access Disparities to Digital Breast Tomosynthesis

Saturday, May 6, 2023

First Author(s)

ES

Elizabeth M. Stoeckl, MD

Resident Physician
University of Wisconsin Hospitals and Clinics
Madison, Wisconsin, United States

Co-Author(s)

OJ

Oyinloye Jose, BA

Medical Student
Meharry Medical College, United States
AK

Angela Kristo, BS

Medical Student
University of Wisconsin, School of Medicine and Public Health, Wisconsin, United States
ML

Manlu Liu, BA

Medical Student
University of Wisconsin, School of Medicine and Public Health, United States
AW

Amelia Wagner, BA

Research Assistant
University of Wisconsin, United States
IW

Ian A. Weissman, DO, FACR

Chair ACR PFCC Outreach Comm, Chair ACR GSER VA Comm, President Wisconsin Radiological Society
Milwaukee VA Medical Center
Milwaukee, Wisconsin, United States
Efrén J. Flores, MD

Radiologist / Officer, Radiology Community Health & Equity
Massachusetts General Hospital
Boston, Massachusetts, United States
AN

Anand K. Narayan, MD, PhD

Vice Chair of Equity, Associate Professor, Department of Radiology
University of Wisconsin, United States
VM

Victoria L. Mango, MD

Associate Attending Radiologist, Director of Radiology at MSK Ralph Lauren Center
Memorial Sloan Kettering Cancer Center, United States
RM

Randy C. Miles, MD, MPH

Chief of Breast Imaging and Associate Director of Radiology for Research
Denver Health, United States

Purpose: To evaluate the effects of neighborhood deprivation at the zip code level on access to FDA accredited breast imaging facilities with digital breast tomosynthesis (DBT).

Methods/Materials: Area deprivation index (ADI) values were obtained from the University of Wisconsin Neighborhood Atlas, which ranks zip code level socioeconomic disadvantage across the United States. Disadvantage was dichotomized (high ≥97th ADI percentile, low ≤3rd ADI percentile). Among FDA accredited breast imaging facilities, a random sample was obtained, stratified by ADI values. Facilities were contacted and asked about DBT availability, out-of-pocket DBT fees, transportation assistance, and appointment availability. Chi-square tests evaluated the association between access metrics and socioeconomic disadvantage. A sample size of 75 zip codes in each group (high vs. low ADI) had 87% power to detect a 20% difference in DBT access.

Results: Of 231 randomly selected facilities, 220 (95.2%) provided information on DBT access. Of these, 142 (65%) were in high deprivation areas and 78 (35%) in low deprivation areas. Overall, 91.8% (202/220) of facilities reported having DBT: 88.5% in low deprivation areas vs. 93.7% in high deprivation areas reported DBT access (p = 0.178). Among facilities with DBT access, 73.3% of facilities in low deprivation areas reported performing DBT in all patients vs. 63.6% of facilities in high deprivation areas reported performing DBT in all patients (p = 0.190). Areas with higher deprivation indices were less likely to provide DBT on weekends (p < 0.001). There was no difference between lower and higher deprivation area facilities providing DBT during evenings (p = 0.317) or transportation assistance (p = 0.861). Among facilities reporting DBT costs, costs ranged from $0 to $750 (median $250), with no significant difference in average cost between high and low ADI zip codes (p = 0.977).

Conclusions: High proportions of breast imaging facilities in areas with low and high levels of deprivation have DBT; however, out-of-pocket costs and weekend appointment availability vary. Reducing financial costs and increasing evening/weekend appointment availability may increase the routine utilization of DBT.