Medicare Coverage and Decreased Disparities in Rates of Mammography Screening Among Black Women in the Delta

Background: In the Delta, as defined by the Delta States Stroke Consortium, black women experience poorer health outcomes and lower life expectancies possibly due, in part, to lower rates of screening for cancer . In 1991, Medicare began reimbursing providers for mammography screening. We hypothesized that Medicare coverage decreases disparities in rates of mammography .

Objective: Estimate the race-specific likelihood of obtaining regular mammography screening , defined as at least two mammograms in four years, by comparing 1992-1995 (T1) with 2005-2008 (T2) among Medicare beneficiaries, ages 65-74 years.

Methods: A non-proportional, stratified sample was drawn to maximize black representation. Medicare billing records were reviewed to identify women obtaining regular mammography screening . Logistic regression was used to estimate the likelihood of regular mammography screening .

Results: The sample included 153,857 (T1) and 128,919(T2) black women aged 65-74 years. At T1, , black beneficiaries residing in the Delta were 49% less likely to obtain regular screening (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.50-0.53) than blacks residing elsewhere. By T2 , this difference declined to 25% (OR 0.75, 0.73-0.76). (p< 0.001) for the change from T1 to T2) )

Conclusions: In the Delta, Medicare coverage was associated with a significant decrease in mammography screening disparities among black women in the Delta. These descriptive data are compatible with the hypothesis that Medicare coverage, which increased rates of regular mammography screening by black women in the Delta, may contribute to decreases in disparities in mortality.