Black-White Disparities in Elderly Breast Cancer Mortality Before and After Implementation of Medicare Benefits for Screening Mammography

• Published in: Journal of health care for the poor and underserved Vol. 19; no. 1; pp. 103 - 134
• Main Authors: Levine, Robert S, Briggs, Nathaniel C, Roberts, Kimyona, Kilbourne, Barbara E, Husaini, Baqar A, Baltrus, Peter A, Rust, George E, Williams-Brown, Shanita, Caplan, Lee
• Format: Journal Article
• Language: English
• Published: United States Johns Hopkins University Press 01.02.2008
• Subjects: African Americans; Aged; Aged, 80 and over; Black American people; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - ethnology; Breast Neoplasms - mortality; Cervical cancer; Disease control; Ethnicity; European Continental Ancestry Group; Female; Government programs; Health care policy; Healthcare Disparities - ethnology; Humans; Low income elderly people; Mammography; Mammography - utilization; Medicare; Medicare - statistics & numerical data; Mortality; Mortality rate; Older people; Poverty; Race; Risk Factors; Socioeconomic Factors; Socioeconomics; United States; Urban areas; Womens health; United States
• ISSN: 1049-2089; 1548-6869; 1548-6869
• DOI: 10.1353/hpu.2008.0019

Medicare implemented reimbursement for screening mammography in 1991. 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. 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.