Geographic Analysis of Digital Breast Tomosynthesis Availability in High- and Low-Deprivation Areas

To evaluate the association between zip code-level neighborhood deprivation and availability to digital breast tomosynthesis (DBT) at FDA-accredited breast imaging facilities.

Area Deprivation Index (ADI) values were obtained from the University of Wisconsin Neighborhood Atlas, which ranks zip code-level socio-economic disadvantage across the United States. Classification of high-disadvantage and low-disadvantage zip codes was dichotomized (high ≥ 97th national ADI percentile, low ≤ 3rd ADI percentile). Among FDA-accredited breast imaging facilities, a random sample was obtained, stratified by ADI values. DBT availability, out-of-pocket DBT fees, transportation assistance, availability of DBT educational resources, appointment availability, and flexible scheduling offerings was obtained from each facility.

Among 220 facilities sampled, 91.8% (202 of 220) reported DBT availability. There was no observed difference in overall DBT, after-hour evening, and transportation service availability between facilities in low- and high-deprivation areas. Of facilities reporting DBT fees (n = 77), the median cost was $250, with no significant difference in average fees across ADI zip codes. A higher proportion of facilities in low-deprivation areas, however, offered DBT services on weekends compared with those in high-deprivation areas (50% versus 23.1%, P < .001). Compared with high-deprivation areas, facilities in low-deprivation areas also more frequently significantly offered online scheduling.

Most breast imaging facilities in both high- and low-deprivation areas offer DBT, with comparable availability rates across neighborhoods. Addressing cost concerns, offering online scheduling and expanding weekend appointment availability may represent key opportunities to improve DBT utilization across sociodemographic groups.