BLACK-WOMEN RECEIVE LESS MAMMOGRAPHY EVEN WITH SIMILAR USE OF PRIMARY-CARE

Background: Black women with breast cancer have a decreased 5-year sur vival rate in comparison with white women, possibly because of less fr equent use of mammography. Having a regular provider or source of heal th care is the most important determinant of mammography use. Objectiv e: To examine whether the difference in mammography use between elderl y black women and elderly white women is related to the number of visi ts made to a primary care physician. Design: Retrospective review of 1 990 Health Care Financing Administration billing files (Medicare part B) from 10 states. Setting: Outpatient mammography services in 10 stat es. Participants: Black women and white women, 65 years of age and old er, residing in one of the 10 states. Measurements: Any mammogram. Pre dictors included race, number of visits to a primary care physician (O , 1, 2, or 3 or more), median income of ZIP code of residence (a surro gate measure of income), and state. Results: The following are finding s from Georgia; similar results were found in each state studied. The mean age of the 335 680 women was 75 years; 20% were black. Sixty-eigh t percent of the black women and 69% of the white women made at least one visit to a primary care physician. Overall, 14% of the women had h ad mammography; black women had mammography less often than white wome n (9% compared with 15%). At each primary care visit level (1, 2, or 3 or more visits), black women had mammography less often than white wo men (1 visit, 7% compared with 15%; 2 visits, 12% compared with 21%, a nd 3 or more visits, 12% compared with 20%). Even among women who had made at least one visit to a primary care physician, a deficit for bla cks occurred in each income quintile (lowest quintile, 13% compared wi th 20%; low, 10% compared with 18%; middle, 12% compared with 18%; hig h, 10% compared with 19%; and highest, 12% compared with 22%) and in e ach state (in Georgia, for example, the percentages were 14% compared with 21%). An age-, income-, and state-adjusted logistic model predict ing mammography use for 2.9 million white women in all 10 states shows the powerful effect of primary care use on mammography (odds ratios f or 1, 2, and 3 or more visits were, respectively, 2.73 [95% Cl, 2.70 t o 2.77]; 3.98 [Cl, 3.93 to 4.03]; and 4.62 [Cl, 4.58 to 4.67]). The sa me model fit to 250 000 black women shows a lesser effect (analogous o dds ratios were 1.77 [Cl, 1.67 to 1.87]; 2.49 [Cl, 2.36 to 2.63]; and 3.15 [Cl, 3.04 to 3.25]). Conclusions: Among older women, mammography is used less often for blacks than for whites. More frequent use of ma mmography is associated with more visits to a primary care physician i n both groups, but the deficit for black women persists at each income level and in each state, even after primary care use is considered. P rimary care visits are less likely to ''boost'' mammography use for bl ack women than for white women.