Breast cancer screening among Medicare Advantage enrollees with dementia
Abstract Background The decision to screen for breast cancer among older adults with dementia is complex and must often be individualized, as these individuals have an elevated risk of harm from over-screening. Medicare beneficiaries with dementia are increasingly enrolling in Medicare Advantage pla...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-024-10740-7 |
| _version_ | 1827321484113084416 |
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| author | Eli Raver Wendy Y. Xu Jeah Jung Sunmin Lee |
| author_facet | Eli Raver Wendy Y. Xu Jeah Jung Sunmin Lee |
| author_sort | Eli Raver |
| collection | DOAJ |
| description | Abstract Background The decision to screen for breast cancer among older adults with dementia is complex and must often be individualized, as these individuals have an elevated risk of harm from over-screening. Medicare beneficiaries with dementia are increasingly enrolling in Medicare Advantage plans, which typically promote receipt of preventive cancer screening among their enrollees. This study examined the utilization of breast cancer screening among Medicare enrollees with dementia, in Medicare Advantage and in fee-for-service Medicare. Methods We conducted a pooled cross-sectional study of women with Alzheimer’s disease and related dementias or cognitive impairment who were eligible for mammogram screening. We used Medicare Current Beneficiary Survey data to identify utilization of biennial mammogram screening between 2012 and 2019. Poisson regression models were used to estimate prevalence ratios of mammogram utilization and to calculate adjusted mammogram rates for Medicare Advantage and fee-for-service Medicare enrollees with dementia, and further stratified by rurality and by dual eligibility for Medicare and Medicaid. Results Mammogram utilization was 16% higher (Prevalence Ratio [PR] 1.16; 95% CI: 1.05, 1.29) among Medicare Advantage enrollees with dementia, compared to their counterparts in fee-for-service Medicare. Rural enrollees experienced no significant difference (PR 0.99; 95% CI: 0.72, 1.37) in mammogram use between Medicare Advantage and fee-for-service Medicare enrollees. Among urban enrollees, Medicare Advantage enrollment was associated with a 21% higher mammogram rate (PR 1.21; 95% CI: 1.09, 1.35). Dual-eligible Medicare Advantage enrollees had a 34% higher mammogram rate (PR 1.34; 95% CI: 1.10, 1.63) than dual-eligible fee-for-service Medicare enrollees. Among non-dual-eligible enrollees, adjusted mammogram rates were not significantly different (PR 1.11; 95% CI: 0.99, 1.24) between Medicare Advantage and fee-for-service Medicare enrollees. Conclusions Medicare beneficiaries age 65–74 with Alzheimer’s disease and related dementias or cognitive impairment had a higher mammogram use rate when they were enrolled in Medicare Advantage plans compared to fee-for-service Medicare, especially when they were dual-eligible or lived in urban areas. However, some Medicare Advantage enrollees with Alzheimer’s disease and related dementias or cognitive impairment may have experienced over-screening for breast cancer. |
| first_indexed | 2024-04-25T01:06:57Z |
| format | Article |
| id | doaj.art-48e852dff0a94d4db18936e521625a1c |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-25T01:06:57Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-48e852dff0a94d4db18936e521625a1c2024-03-10T12:09:10ZengBMCBMC Health Services Research1472-69632024-03-0124111010.1186/s12913-024-10740-7Breast cancer screening among Medicare Advantage enrollees with dementiaEli Raver0Wendy Y. Xu1Jeah Jung2Sunmin Lee3Division of Health Services Management and Policy, College of Public Health, The Ohio State UniversityDivision of Health Services Management and Policy, College of Public Health, The Ohio State UniversityDepartment of Health Administration and Policy, College of Public Health, George Mason UniversityDepartment of Medicine, School of Medicine & Chao Family Comprehensive Cancer Center, University of California, IrvineAbstract Background The decision to screen for breast cancer among older adults with dementia is complex and must often be individualized, as these individuals have an elevated risk of harm from over-screening. Medicare beneficiaries with dementia are increasingly enrolling in Medicare Advantage plans, which typically promote receipt of preventive cancer screening among their enrollees. This study examined the utilization of breast cancer screening among Medicare enrollees with dementia, in Medicare Advantage and in fee-for-service Medicare. Methods We conducted a pooled cross-sectional study of women with Alzheimer’s disease and related dementias or cognitive impairment who were eligible for mammogram screening. We used Medicare Current Beneficiary Survey data to identify utilization of biennial mammogram screening between 2012 and 2019. Poisson regression models were used to estimate prevalence ratios of mammogram utilization and to calculate adjusted mammogram rates for Medicare Advantage and fee-for-service Medicare enrollees with dementia, and further stratified by rurality and by dual eligibility for Medicare and Medicaid. Results Mammogram utilization was 16% higher (Prevalence Ratio [PR] 1.16; 95% CI: 1.05, 1.29) among Medicare Advantage enrollees with dementia, compared to their counterparts in fee-for-service Medicare. Rural enrollees experienced no significant difference (PR 0.99; 95% CI: 0.72, 1.37) in mammogram use between Medicare Advantage and fee-for-service Medicare enrollees. Among urban enrollees, Medicare Advantage enrollment was associated with a 21% higher mammogram rate (PR 1.21; 95% CI: 1.09, 1.35). Dual-eligible Medicare Advantage enrollees had a 34% higher mammogram rate (PR 1.34; 95% CI: 1.10, 1.63) than dual-eligible fee-for-service Medicare enrollees. Among non-dual-eligible enrollees, adjusted mammogram rates were not significantly different (PR 1.11; 95% CI: 0.99, 1.24) between Medicare Advantage and fee-for-service Medicare enrollees. Conclusions Medicare beneficiaries age 65–74 with Alzheimer’s disease and related dementias or cognitive impairment had a higher mammogram use rate when they were enrolled in Medicare Advantage plans compared to fee-for-service Medicare, especially when they were dual-eligible or lived in urban areas. However, some Medicare Advantage enrollees with Alzheimer’s disease and related dementias or cognitive impairment may have experienced over-screening for breast cancer.https://doi.org/10.1186/s12913-024-10740-7Medicare AdvantageBreast cancer screeningAlzheimer’s disease and related dementias |
| spellingShingle | Eli Raver Wendy Y. Xu Jeah Jung Sunmin Lee Breast cancer screening among Medicare Advantage enrollees with dementia BMC Health Services Research Medicare Advantage Breast cancer screening Alzheimer’s disease and related dementias |
| title | Breast cancer screening among Medicare Advantage enrollees with dementia |
| title_full | Breast cancer screening among Medicare Advantage enrollees with dementia |
| title_fullStr | Breast cancer screening among Medicare Advantage enrollees with dementia |
| title_full_unstemmed | Breast cancer screening among Medicare Advantage enrollees with dementia |
| title_short | Breast cancer screening among Medicare Advantage enrollees with dementia |
| title_sort | breast cancer screening among medicare advantage enrollees with dementia |
| topic | Medicare Advantage Breast cancer screening Alzheimer’s disease and related dementias |
| url | https://doi.org/10.1186/s12913-024-10740-7 |
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