Racial, Geographic Disparities in Mammography Uptake Persist Among Texan Medicare Beneficiaries

Medicare beneficiaries who live in rural areas are much less likely to be regular users of mammography than their counterparts in urban areas, especially Hispanics and non-Hispanic Blacks (NHBs), according to the results of a new study in Geriatric Nursing.

With the knowledge that NHB women and Hispanic women have higher likelihoods of late-stage breast cancer diagnosis and cancer-related mortality than White women, a team of researchers set out to learn more about racial and geographic disparities in mammography utilization among older women.

They conducted a retrospective longitudinal study, using data from female Medicare beneficiaries ages 65 to 74 in Texas who enrolled during the time period 2010 to 2013. A total of 114,939 beneficiaries were eligible for the study cohort. 

NHB beneficiaries who lived in urban areas were found to have similar mammography utilization rates to non-Hispanic White (NHW) women. “However, NHB women in rural areas had the second lowest screening rate, after Hispanics,” the researchers reported. “Coupled with NHB women having a 40% higher mortality rate than NHW women, they are at increased risk of experiencing the worst cancer outcomes.”

Specifically, 21.2% of the Hispanic women, 33.3% of the NHB women, and 38.4% of the NHW women who lived in rural areas were regular users of mammography, compared with 33.5%, 44.9%, and 45.3%, respectively, of their counterparts who lived in urban areas of the state. 

Additionally, Hispanic women and NHB women who lived in rural areas were 33% and 22%, respectively, less likely to be regular users of mammography than Hispanic and NHB women in urban areas. 

The researchers did not find any significant difference among NHW women who were regular users of mammography based on geography. 

The researchers emphasized that the lack of a regular primary care provider and overall health status, as indicated by hospitalization frequency and comorbidity burden, were 2 major barriers to long-term adherence to mammography recommendations, which could provide useful insight for future actions to address the disparities. For example, beneficiaries who had an established primary care provider were found to be 3.31 times more likely to regularly utilize mammography (95% CI, 3.2-3.42). 

Limitations of this study include its use of Medicare claims data, a focus on female Medicare beneficiaries aged 65 to 74 with fee-for-service plans, and the study population was exclusively Medicare beneficiaries in Texas. Therefore, “[r]egional variations and contextual factors could influence the observed disparities,” the researchers noted.

“These findings highlight the importance of addressing rural racial/ethnic disparities and implementing targeted interventions to enhance screening mammography utilization and to achieve equitable screening practices for all populations,” they concluded.

Reference

Liu Z, Shan Y, Kuo Y, et al. Rural racial disparities and barriers in mammography utilization among Medicare beneficiaries in Texas: a longitudinal study. Geriatric Nursing. 2024;55:14-20. https://doi.org/10.1016/j.gerinurse.2023.10.019