Association between Vision Loss and Screening Mammography among Women with Medicare

Abstract

Purpose : To assess whether visual impairment affects receiving screening mammograms to check for breast cancer in accordance with USPSTF recommendations.

Methods : Females aged 65-72 years with severe, partial, and no vision loss were identified from a 20% sample of enrollees in Medicare from 2008-2015. Partial vision loss was defined as visual impairment involving 1 eye, and severe as visual impairment involving 2 eyes, using qualifying ICD-9 codes. Patients were matched 1:1:1 across groups based on age, calendar year at start of follow up, race, urban-rural category of residence, and overall health. Women with pre-existing breast cancer were excluded. We studied the receipt of screening mammography within a 3-year look-back and 2-year follow-up period among the 3 groups. Multivariable conditional logistic regression modeling determined the odds of receiving screening mammography among visually impaired women compared to those without vision loss.

Results : A total of 1,044 patients were identified and matched (348 patients in each of the 3 groups). The mean number of mammograms received per patient during the 5-year period was 2.3 (SD 2.1), 2.5 (SD 2.0), and 3.1 (SD 2.0) for the severe, partial, and no vision loss groups, respectively (p<0.0001). The proportion of women receiving ≥ 1 mammogram within the 2-year follow-up period was 56%, 57%, and 69% for the severe, partial, and no vision loss groups, respectively (p=0.0005). After adjusting for prior mammograms during the look-back period and receipt of colonoscopy (another preventative screening test) during the study period, the group of patients with severe vision loss had 42% decreased odds (OR=0.58; 95% CI 0.37-0.90), and the group with partial vision loss had 44% decreased odds (OR=0.56; 95% CI 0.36-0.87) of receiving mammography during the follow-up period compared with the group of patients without vision loss.

Conclusions : Within this Medicare cohort, women with visual impairment were significantly less likely to receive screening mammography to check for breast cancer than their non-visually-impaired peers. Health care professionals should look for ways to help ensure that patients with visual or other disabilities receive mammograms and other preventative screenings as recommended by the USPSTF.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.