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Purpose To evaluate predictors of mammography engagement at the county level to better understand the challenges associated with population-based screening in the United States. Materials and Methods This retrospective, geospatial, cross-sectional study conducted from March 2024 to September 2024 used data from the 2023 National Cancer Institute's Small Area Estimates, County Health Rankings, and the Atlas of Rural and Small-Town America. Univariable linear regression analyses were conducted to evaluate the relationship between sociodemographic variables and county-level mammography screening rates. Multivariable linear regression was performed to create an average model of mammography screening rates as a function of county-level sociodemographic variables, which was then used to assess county screening performance after adjusting for these factors. Results Information obtained from 3121 counties was included in this study. Higher percentages of White residents, residents older than 18 years, women, rural residents, and high school graduates were positively associated with county-level screening rates, while higher percentages of non-Black minority residents, residents with limited English proficiency, and uninsured residents were negatively associated with county-level mammography screening rates (P < .001). After accounting for sociodemographic composition, counties with a higher proportion of Black residents (P < .001), residents with limited English proficiency (P = .009), insured residents (P < .001), high school graduates (P < .001), and residents with higher median income (P < .001) exceeded expected screening rates based on national county-level data. Conclusion In this national county-level model, population-based characteristics associated with mammography engagement at the county level could be used to estimate expected screening rates based on each county's sociodemographic profile. Keywords: Mammography, Breast, Screening, Socioeconomic Issues, Oncology, Epidemiology, Statistics, Health Policy and Practice ©RSNA, 2025.