Black-white disparities in elderly breast cancer mortality before and after implementation of Medicare benefits for screening mammography

J Health Care Poor Underserved. 2008 Feb;19(1):103-34. doi: 10.1353/hpu.2008.0019.

Abstract

Background: Medicare implemented reimbursement for screening mammography in 1991.

Main findings: Post-implementation, breast cancer mortality declined faster (p< .0001) among White than among Black elderly women (65+ years). No excess breast cancer deaths occurred among Black elderly compared with White elderly through 1990; over 2,459 have occurred since. Contextual socioeconomic status does not explain differences between counties with lowest Black breast cancer mortality/post-implementation declines in disparity and counties with highest Black breast cancer mortality/widened disparity post-implementation.

Conclusions: The results lead to these hypotheses: (a) Medicare mammography reimbursement was causally associated with declines in elderly mortality and widened elderly Black:White disparity from breast cancer; (b) the latter reflects inherent Black-White differences in risk of breast cancer death; place-specific, unaddressed inequalities in capacity to use Medicare benefits; and/or other factors; (c) previous observations linking poverty with disparities in breast cancer mortality are partly confounded by factors explained by theories of human capability and diffusion of innovation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Black or African American
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / ethnology*
  • Breast Neoplasms / mortality*
  • Female
  • Healthcare Disparities / ethnology*
  • Humans
  • Mammography / statistics & numerical data*
  • Medicare / statistics & numerical data*
  • Risk Factors
  • Socioeconomic Factors
  • United States
  • White People