Rural – urban disparity in breast cancer screening among elder Medicare beneficiaries: Does rurality matter?

Background: Few studies have examined the urban-rural disparity of breast cancer screenings among elder Medicare beneficiaries. Further, few studies have assessed the independent impact of rurality on receipt of mammogram. Methods: We included community dwelling female beneficiaries aged >65 from 2005 Medicare Current Beneficiary Survey (MCBS). Rural-Urban Commuting Area Codes (RUCAs) were used to characterize 4 categories of rural and urban status. Self report mammogram in last year was compared among the 4 areas; the independent impact of rurality on mammogram was evaluated using weighted logistic regression controlling for SES and health status variables. Results: 53.0% (95% CI: 51.1% - 54.8%) of urban beneficiaries, 51.8% (95% CI: 47.3% - 56.3%) of those from large rural / town, 45.2% (95% CI: 37.5% - 52.9%) from small rural / town, and 44.0% (95% CI: 38.8% - 49.1%) from isolated rural / town had mammogram last year (P=0.0107). After controlling for age and race, rurality is still significantly associated with receipt of mammogram (P=0.0154). After further controlling for income, education, health insurance, HMO, health status, and health conditions, rurality is no longer significantly associated with receipt of mammogram (P=0.1644). Conclusion: There is evidence of urban-rural disparity for receipt of mammogram; SES and health status factors totally eliminated the urban-rural disparity. Health promotions to improve the use of mammogram should focus more on small and isolated rural / towns. Programs aiming at SES (income, education, and health insurance) mechanism will most likely reduce the disparity to a great extent.