Methods: A cross-sectional survey was conducted with a convenience sample of 461 KAIW residing in the Eastern 12-county (eNC-12), Eastern 29-county (eNC-29), and Piedmont (PNC) regions of North Carolina. The survey was either self-administered or conducted face-to-face. The mean age of study participants was 55.38 years old (SD= 9.21). On average they lived in the United States for 23.35 years (SD= 12.15). About 90.39% of the participants completed high school or higher education, and 35.14% reported their income was less than $50,000 per year. Unadjusted and adjusted multivariable logistic regression models were conducted to examine factors associated with KAIW mammography using SAS® statistical software version 9.4.
Results: KAIW who lived in eNC-29 had lower odds of receiving a mammogram in the past 2 years compared to those living in the PNC region (AOR=0.52, 95% CI: <0.27, 0.98). However, KAIW living in eNC-12 had greater odds of mammogram uptake compared to PNC residents (AOR= 1.11, 95% CI: <0.55, 2.22). Women with health insurance (AOR=3.59, 95% CI: <1.77, 7.32) and those aware of free or low-cost screening services (AOR=9.66, 95% CI:4.78, 19.55) also had greater odds of mammogram screening in the past 2 years.
Conclusions and Implications: We found that in the poor rural settings (eNC-29) there is lower odds of screening compared with the PNC region, after adjusting for all other factors. This is aligned with other research findings that rural areas have lower screening rates (Chandak et al., 2019). Unadjusted screening data indicated higher screening in eNC-12, also a rural area. This may have been due to resources available to some KAIW in that area (e.g., military presence and access to insurance). As a novel study examining regional differences in mammography uptake among KAIW in North Carolina, our findings highlight the factors and opportunities for intervention that could be tailored to each region and increase screening.