Neighborhood and language influences on mammography receipt among latinas in community health centers

Background: Breast cancer is a significant source of mortality and morbidity for Latinas in the United States. Literature has shown that breast cancer survival and diagnosis stage may be associated with neighborhood factors, but less is known about how these factors affect mammogram receipt specifically. Therefore, we performed an analysis of mammography receipt in Latina patients, by language preference, compared to non-Hispanic White women, by multiple community level factors (transportation access, economic level, education level). Methods: We used electronic health record data from 59,646 Latina and non-Hispanic White patients between the ages of 50 and 74 receiving care at 594 community health centers across 21 states, along with geocoded census-tract-level neighborhood data to evaluate the prevalence of mammogram completion by neighborhood characteristics, including high school graduation rates, community poverty as percent of the federal poverty level, percent of households with a vehicle and with a 60+minute public transit commute. We stratified Latina patients by language preference and adjusted for common individual demographic and clinical characteristics. Results: In the sample, 3,987 patients were non-Hispanic White, 11,338 were English-preferring Latinas, and 44,381 were Spanish-preferring Latinas. A higher proportion of Latinas lived in high poverty census tracts. A higher prevalence of non-Hispanic White women were smokers. Spanish-preferring Latinas (67.2%) had a higher unadjusted prevalence of mammogram receipt than English-preferring Latinas (57.7%) and non-Hispanic white women (54.6%). In covariate-adjusted analyses, Spanish preferring Latinas had the highest prevalence of being up-to-date with their mammograms, and of having completed mammograms if ordered, regardless of community characteristics. Across community characteristics, there was no difference in outcome prevalence within ethnicity language groupings. Conclusion: In an analysis of mammogram completion in Latina and non-Hispanic white women by neighborhood-level factors in a national network of community health centers, mammogram prevalence was low. Spanish-preferring Latinas had the highest prevalence of mammogram receipt.There was no outcome difference in any group across neighborhood-level factors. Community health centers are vital in the early detection of breast cancer for Latinas, but clinics should understand the limitations of community level factors in targeting improved mammogram completion and be aware of individual barriers that may reduce mammography in Latinas.