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Mammography utilization among Black and White Medicare beneficiaries in high breast cancer mortality US counties

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Abstract

Background

Disparities in US breast cancer mortality between older Black and White women have increased in the last 20 years. Regular mammography use is important for early detection and treatment: its utilization among older Blacks especially in counties with high Black mortality is of interest, but its extent and determinants are unknown.

Methods

We used Medicare claims for Black and White women 65–74 years old in 203 counties with the highest Black breast cancer mortality. Outcomes over 6 years were as follows: ever mammogram, i.e., ≥ 1 screening mammogram, and regular mammogram, i.e., ≥ 3 mammograms. With logistic regressions, we examined the independent effect of race on screening controlling for individual- and county-level factors.

Results

Of 406,602 beneficiaries, 17 % were Black. Ever and regular mammogram was significantly lower among Blacks (51.6 vs. 56.9 %; 32.9 vs. 43.1 %, respectively). Controlling for covariates, including use of cervical cancer screening, flu shots, or lipids tests, Black women were more likely to have ever mammogram (OR 1.23, CI 1.20–1.25), but not regular mammogram (OR 0.95, CI 0.93–0.97) than White women. County-level managed care penetration was negatively associated with ever and regular mammograms.

Conclusions

In Medicare enrollees from these counties, breast cancer screening was low. Black women had same or better odds of screening than White women. Some health care factors, e.g., managed care, were negatively associated with screening. Further studies on the determinants of mammography utilization in older women from these counties are warranted.

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Acknowledgments

This work was funded by the National Cancer Institute (U54CA118948). M. Virk-Baker and T. Nagy were supported in part by the UAB Cancer Prevention and Control Training Program (R25CA047888). R. Levine was partially supported by the National Center for Minority Health and Health Disparities (2P20MD000516-05A1).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA

    Mandeep K. Virk-Baker & Tim R. Nagy

  2. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA

    Michelle Y. Martin, Tim R. Nagy & Maria Pisu

  3. Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL, 35294-4410, USA

    Michelle Y. Martin, Xin Wang & Maria Pisu

  4. Meharry Medical College, Nashville, TN, USA

    Robert S. Levine

Authors
  1. Mandeep K. Virk-Baker
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  2. Michelle Y. Martin
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  3. Robert S. Levine
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  4. Xin Wang
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  5. Tim R. Nagy
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  6. Maria Pisu
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Corresponding author

Correspondence to Maria Pisu.

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The opinions expressed herein are those of the authors and not necessarily those of the National Institutes of Health or any other organization with which the authors are affiliated.

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Virk-Baker, M.K., Martin, M.Y., Levine, R.S. et al. Mammography utilization among Black and White Medicare beneficiaries in high breast cancer mortality US counties. Cancer Causes Control 24, 2187–2196 (2013). https://doi.org/10.1007/s10552-013-0295-9

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  • DOI: https://doi.org/10.1007/s10552-013-0295-9

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