Low income, race, and the use of mammography

Objective. To describe national trends in mammography use by race and incom e and to test whether higher use of mammography among low-income African Am erican women than low-income white women can be explained by health insuran ce coverage, usual place of health care, or place of residence. Data Sources/Study Setting. Data from five years of the National Health Int erview Survey spanning the period 1987-1994. Study Design. Trends in the percentage of women 50-64 years of age with a m ammogram within the past two years were analyzed by race and income. Data f or 1993-1994 were pooled, and with logistic regression analysis, variation in use of recent mammography for low-income women was investigated. Indepen dent variables are age, race, family income, education, health insurance co verage, place of usual source of health care, metropolitan residence, and g eographic region. Data Collection/Extraction Methods. The National Health Interview Survey is a cross-sectional national survey conducted by the National Center for Hea lth Statistics. Data are collected through household interviews. [Editor's note: in keeping with HSR policy, the term black is used to conform to its use in the surveys studied. In other references to race, the term African A merican is used.] Principal Findings. Among women 50-64 years of age use of recent mammograms increased rapidly between 1987 and 1991 for all groups of women, and betwe en 1991 and 1991 the increases slowed. However, increases between 1991 and 1994 have been more rapid among low-income black women than among low-incom e white women. In 1993-1994, low-income black women were about one-third mo re likely than low-income white women to report mammography within the past two years. This difference could not be explained by health insurance cove rage, usual source of health care, metropolitan status, or region of reside nce. Conclusions. These results, which provide some evidence of success for scre ening programs targeted to the poor, raise the question of why low-income b lack women appear to be to more likely than low-income white women to have benefited from recent efforts to promote mammography. Continued evaluation of mammography programs focused on women who are underserved as well as the monitoring of trends and variations in service use by race and income are needed.