Black-White Disparities in Elderly Breast Cancer Mortality Before and After Implementation of Medicare Benefits for Screening Mammography
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 199...
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Published in | Journal of health care for the poor and underserved Vol. 19; no. 1; pp. 103 - 134 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Johns Hopkins University Press
01.02.2008
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Subjects | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1049-2089 1548-6869 1548-6869 |
DOI: | 10.1353/hpu.2008.0019 |