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ORIGINAL RESEARCH article

Front. Med.

Sec. Healthcare Professions Education

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1644287

This article is part of the Research TopicDissemination and Implementation Science in MedicineView all 8 articles

Modeling the Impact of Social Determinants on Breast Cancer Screening: A Data-Driven Approach

Provisionally accepted
  • 1Dartmouth College Geisel School of Medicine, Hanover, United States
  • 2Dartmouth College, Hanover, United States
  • 3Dartmouth College Thayer School of Engineering, Hanover, United States

The final, formatted version of the article will be published soon.

Background: This study addresses the critical science challenge of operationalizing social determinants of health (SDoH) in clinical practice. We develop and validate models demonstrating how SDoH predicts mammogram screening behavior within a rural population. Our work provides healthcare systems with an evidence-based framework for translating SDoH data into effective interventions. Methods: We model the relationship between SDoH and breast cancer screening adherence using data from over 63,000 patients with established primary care relationships within the Dartmouth Health System, an academic health system serving northern New England through seven hospitals and affiliated ambulatory clinics. Our analytical framework integrates multiple machine learning techniques including light gradient boosting machine, random forest, elastic-net logistic regression, Bayesian regression, and decision tree classifier with SDoH questionnaire responses, demographic information, geographic indicators, insurance status, and clinical measures to quantify and characterize the influence of SDoH on mammogram scheduling and attendance. Results: Our models achieve moderate discriminative performance in predicting screening behaviors, with an average Area Under the Receiver Operating Characteristic Curve (ROC AUC) of 71% for scheduling and 70% for attendance in validation datasets. Key social factors influencing screening behaviors include geographic accessibility measured by the Rural-Urban Commuting Area, neighborhood socioeconomic status captured by the Area Deprivation Index, and healthcare access factors related to clinical sites. Additional influential variables include months since the last mammogram, current age, and the Charlson Comorbidity Score, which intersect with social factors influencing healthcare utilization. By systematically modeling these SDoH and related factors, we identify opportunities for healthcare organizations to transform SDoH data into targeted, facility-level intervention strategies while adapting to payer incentives and addressing screening disparities. Conclusions: Our model provides healthcare systems with a data-driven approach to understanding and addressing how SDoH shape mammogram screening behaviors, particularly among rural populations. This framework offers valuable guidance for healthcare providers to better understand and improve patients’ screening behaviors through targeted, evidence-based interventions.

Keywords: Predictive Modeling, machine learning, cancer screening, implementation science, breast cancer

Received: 10 Jun 2025; Accepted: 31 Jul 2025.

Copyright: © 2025 Ma, Scully, Luo, Feng, Gunn, DiFlorio Alexander, Tosteson, Kraft and Marrero. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Wesley Marrero, Dartmouth College Thayer School of Engineering, Hanover, United States

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