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Effects of Spatial Accessibility on Preventive Healthcare Behaviors: impacts on screening mammography

Pyda, Sarada
http://rave.ohiolink.edu/etdc/view?acc_num=osu1471876065

Abstract Details

2016, Doctor of Philosophy, Ohio State University, Agricultural, Environmental and Developmental Economics.
This research examines the uptake of preventive healthcare by studying the relationship between spatial access to mammography facilities and the uptake of screening mammography. In the first essay, by including travel times with traditional health access measures in a partial proportional odds model, I am able to determine which factors, and for whom, inhibit the uptake of screening mammography on a national scale. Unlike previous, smaller scale studies, I find that travel time is not a major determinant of most women’s mammography uptake decisions. Overweight and obese women 50-75 are an exception: a 5 minute increase in travel results in an 11.5% and 9.94% decrease in odds, even though they have 34.6% and 15.0% greater odds of increased uptake compared to that of normal weight women,. I also find that, unlike in previous literature, increasing education does not have a uniformly positive effect on uptake in women over 50. Poor women 40-49 are progressively more likely to have greater uptake of mammography than are rich women, but an additional five minutes of travel results in a 41.8% decrease in the odds of greater uptake. Most alarmingly, I find that black women 40-49 have approximately equal probabilities of uptake to white women of the same age, despite having much higher levels of breast cancer risk. In the second essay, I conduct a sensitivity analysis of several methods of measuring spatial accessibility to healthcare to determine which methods are most practical for different types of analyses. I compare population to provider ratios, the current federal health program designation default, to a number of other indices such as: straight line distance to closest hospital, driving minutes to closest hospital, and the two step floating catchment area. I discuss the advantages and disadvantages of each of these indices and find that travel minutes are the most useful in terms of shaping policy while two step floating catchment areas are most useful in measuring and comparing which areas have the best healthcare access. In the third essay, using zip-code level individual data, I examine the sociodemographics of the regular uptake of screening mammography in metropolitan New Jersey, with an emphasis on spatial accessibility as measured by travel time to the closest mammography facility. I improve on past studies by including an approximation of car ownership and show that travel minutes do not significantly affect a woman’s probability of greater uptake, unlike in previous literature. I find that car access has a very large, though diminishing, effect. I also include a border crossing approximation and find that border crossing is not a significant barrier to care, building on previous studies that cite border crossing as a study limitation.
Alessandra Faggian (Advisor)
Mark Partridge (Committee Member)
Brian Roe (Committee Co-Chair)
126 p.
Economics; Geography; Health Care

Recommended Citations

Citations

  • Pyda, S. (2016). Effects of Spatial Accessibility on Preventive Healthcare Behaviors: impacts on screening mammography [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1471876065

    APA Style (7th edition)

  • Pyda, Sarada. Effects of Spatial Accessibility on Preventive Healthcare Behaviors: impacts on screening mammography. 2016. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1471876065.

    MLA Style (8th edition)

  • Pyda, Sarada. "Effects of Spatial Accessibility on Preventive Healthcare Behaviors: impacts on screening mammography." Doctoral dissertation, Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1471876065

    Chicago Manual of Style (17th edition)

osu1471876065
428
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This open access ETD is published by The Ohio State University and OhioLINK.