Researchers at Rush University Medical Center reviewed published literature examining disparities among racial groups in accessing mammography-screening services. They found that women with lower socioeconomic backgrounds, the uninsured, women without a usual source of care, the elderly, recent immigrants, women in rural areas and some racial/ethnic minorities such as Native Americans/Alaskan Natives and Hispanics obtained mammography screenings at a markedly lower rate than the rest of the population.
"We also found that there is evidence that the actual magnitude of these disparities, particularly among low-income racial/ethnic minorities, is underestimated and that disparities persist for some subpopulations of Asian Americans/Pacific Islanders and African Americans," said Dr. Monica Peek, internist at Rush University Medical Center and author of the study.
Peek explained that the national surveys that estimate health behavior in the United States -- The Behavioral Risk Factor Surveillance Survey (BRFSS) and the National Health Interview Survey (NHIS) -- under sample ethnic minorities, particularly those at risk for under-screening. The BRFSS study is primarily a telephone survey, and this method under-samples those who may not have telephones such as persons living in the southern United States, African Americans, Hispanics and Native Americans. Additionally, the questionnaires are typically given in English, and those who are not proficient in English are not eligible to take the survey.
Peek pointed out that in the BRFSS study, only 11.2 percent of women surveyed were uninsured; 75.4 percent were white; 9.7 percent African Americans; 11.1 percent Hispanics, one percent Native Americans and 2.8 percent Asian Americans/Pacific Islanders. Her analysis found that these numbers were sufficient in 51 states for whites but only 35 states for African Americans; 36 states for Hispanics; 11 states for Native Americans; and 10 states for Asian Americans.
"Both BRFSS and NHIS studies rely on self-reported health behavior, which may not accurately reflect the actually receipt of health services," she reported.
Peek reported that this under sampling has health policy implications because if public health officials and researchers assume that some medically under-served groups such as African-Americans have achieved parity, outreach efforts and interventions may be halted or downsized, when these efforts are still very much needed.
Her study did find several methods that seem to be effective at increasing the rates of mammography screening. Outreach efforts that target individuals directly in health care settings were successful in increasing mammography use by 17.6 percent compared with similar efforts in a community setting.
"We found that the most effective patient targeted strategies to increase mammography use are access-enhancing efforts, such as mobile vans, transportation services, and reduced cost mammograms," Peek said.
Contact: Chris Martin or John Pontarelli
Phone: (312) 942-7820 or 942-5579
Email: cmartin@rush.edu or jpontare@rush.edu
Journal of General Internal Medicine