The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

4261.0: Tuesday, November 18, 2003 - Board 8

Abstract #63986

Are women from states with higher income inequality less likely to be screened for breast cancer? A multilevel study

Mario Schootman, PhD, Department of Medicine and Pediatrics, Washington University, 4444 Forest Park, Campus Box 8504, St. Louis, MO 63110, 314-286-1956, mschootm@im.wustl.edu and Elizabeth A. Baker, PhD, School of Public Health, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO 63104.

Objective: The purpose of this study was to determine the association of income inequality and breast cancer screening.

Methods: Data from the 1992-1993 Behavioral Risk Factor Surveillance System were used for women 50-69 years of age. Two groups of women were constructed: 1) those who had a mammogram within two years, and 2) those who had a mammogram more than two years ago or never had a mammogram. The sample was divided into four quartiles based on income inequality (the Gini coefficient) from the 1990 census data. Under investment in community infrastructures, resources, goods and services was aggregated to the state-level and operationalized as per capita spending on police protection, education expenditure, access to primary care physicians and mammography facilities.

Results: Women who resided in states with the highest income inequality (odds ratio=0.80; 95% CI: 0.73 0.89) and women who lived in states with the lowest levels of investment in community infrastructures were less likely to be screened for breast cancer than their counterparts. The association with income inequality remained (odds ratio=0.76; 95% CI: 0.64 0.90) while controlling for all individual-level variables and those representing community infrastructures, resources, goods and services. The effects of income inequality were most pronounced among women whose income was less than $25,000 (odds ratio=0.70; 95% CI: 0.64 0.90).

Conclusions: The findings suggest that utilization of breast cancer screening is a function of not only individual characteristics but also area characteristics.

Learning Objectives:

Keywords: Social Inequalities, Cancer Screening

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Surveillance and Screening: Poster Session

The 131st Annual Meeting (November 15-19, 2003) of APHA