Online Program

Exploring geographic patterns for changes in mammography screening of African American Medicare enrollees

Tuesday, November 3, 2015

Laura Stiel, MA, Department of Social Work and Social Ecology, Loma Linda University, San Bernardino, CA
Samuel Soret, PhD, MPH, School of Public Health, Center for Community Resilience, Loma Linda University, Loma Linda, CA
Susanne Montgomery, PhD, MPH, MS, Behavioral Health Institute, Loma Linda University, Loma Linda, CA
Background: African American (AA) women have lower incidence but higher mortality rates of breast cancer (BC) compared to White women.  One reason suggested for this disparity is lack of timely mammography.  Recently, however, rates of ever having had a mammogram for AA women have surpassed that of all other ethnic groups. 

Objective/purpose: To better understand these patterns of change and evaluate what is associated with them, we mapped geographic locations where the greatest rates of change occurred for AA Medicare enrollees ages 67-69.

Methods: ArcGIS was used to map and assess the distribution of change in mammography in this population across the US at the county level from 2008-2012 based on data from the Dartmouth Atlas of Health Care, using raw and smoothed rates.  Cluster analysis was performed to assess spatial autocorrelation. Basemaps with correlate demographic information will be overlaid to explore patterns of change by environment.

Results: Changes in screening mammography for this population are not consistent across the US.  Certain regions experienced marked increases in rates while others exhibited decreases.  Further, some counties with high rates of change are located in overall low rate change areas, and counties with low rates of change are in areas of overall high rate change.

Discussion/conclusions: Results suggest that in recent years, AA women in some US regions have increased their use of mammography, while those in other regions have shown decreased screening.  We will explore factors contributing to these differences.  Although screening mammography is steeped in policy debates, it is currently the most effective and accessible way of detecting BC early.   By exploring the spatial patterns of change in AA mammography use over time, we believe that we can begin to more systemically explore how policy changes and environments may impact health behaviors that have the potential to decrease health disparities.

Learning Areas:

Provision of health care to the public

Learning Objectives:
Identify areas in the United States with the largest rates of change (increases and decreases) in mammography for female African American Medicare enrollees in recent years Name counties with high rates of change in overall low rate change areas, and counties with low rates of change in overall high rate change areas, and their correlate demographic patterns Discuss the implications of using GIS as a tool for improving understanding of health disparities and evaluating the impact of health interventions

Keyword(s): Geographic Information Systems (GIS), Cancer and Women’s Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD student in Social Policy and Social Research and a Research Assistant for the Loma Linda Center for Health Disparities and Molecular Medicine’s Community Outreach and Partnership Core. In this role, I have served on the on the California Breast Cancer Research Grants Program funded Hair and Health Study. My research involves interdisciplinary, cross-collaborative, and translational approaches, and includes the use of qualitative, quantitative, and GIS methodologies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.