ArticleCancer medicine2026
The Effect of Social Associations on Mammography Screening Disparities in Rural Communities: A County-Level Secondary Analysis.
Article in Cancer medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionMammography screening rates in rural counties are lower compared to urban counties. We hypothesized that social associations may help ameliorate this rural-urban disparity. Thus, the purpose of this ecological study was to explore the relationships among rurality, social associations, and mammography screening.
methodsWe conducted a secondary, county-level analysis of the 2022 County Health Rankings and Roadmaps data. We classified counties as rural or urban (rural-urban continuum code of 4+ vs. others), and we gathered the number of social organizations per 10,000 residents (i.e., "social associations"). We used a structural equation model to examine the direct and indirect effects of rurality and social associations on the mammography screening.
resultsOf 3143 U.S. counties, 1976 (62.9%) were rural. Rural counties have greater social associations compared to urban counties (β = 0.20, SE = 0.02, p < 0.0001). Counties with greater social associations had higher mammography screening rates (β = 0.34, SE = 0.02, p < 0.0001) while rural counties had lower screening rates (β = -0.24, SE = 0.02, p < 0.0001). There was a significant indirect effect of rurality through social associations on mammography screening (β = 0.07, SE = 0.01, p < 0.0001). Living in a rural area in the presence of increased social associations led to increased mammography screening.
conclusionsRural counties have more social associations but a lower rate of mammography screening. These analyzes revealed, however, that social associations buffer the negative relationship between rurality and mammography, leading to increased mammography screening rates. Clinical-community partnerships leveraging social associations could minimize rural mammography screening disparities.
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