Burns R B, McCarthy E P, Freund K M, Marwill S L, Shwartz M, Ash A, Moskowitz M A
Boston University Medical Center Hospital, MA, USA.
Ann Intern Med. 1996 Aug 1;125(3):173-82. doi: 10.7326/0003-4819-125-3-199608010-00002.
Black women with breast cancer have a decreased 5-year survival rate in comparison with white women, possibly because of less frequent use of mammography. Having a regular provider or source of health care is the most important determinant of mammography use.
To examine whether the difference in mammography use between elderly black women and elderly white women is related to the number of visits made to a primary care physician.
Retrospective review of 1990 Health Care Financing Administration billing files (Medicare part B) from 10 states.
Outpatient mammography services in 10 states.
Black women and white women, 65 years of age and older, residing in one of the 10 states.
Any mammogram. Predictors included race, number of visits to a primary care physician (0, 1, 2, or 3 or more), median income of ZIP code of residence (a surrogate measure of income), and state.
The following are findings 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-eight 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 had mammography; black women had mammography less often than white women (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 women (1 visit, 7% compared with 15%; 2 visits, 12% compared with 21%; and 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 blacks occurred in each income quintile (lowest quintile, 13% compared with 20%; low, 10% compared with 18%; middle, 12% compared with 18%; high, 10% compared with 19%; and highest, 12% compared with 22%) and in each state (in Georgia, for example, the percentages were 14% compared with 21%). An age-, income-, and state-adjusted logistic model predicting mammography use for 2.9 million white women in all 10 states shows the powerful effect of primary care use on mammography (odds ratios for 1, 2, and 3 or more visits were, respectively, 2.73 [95% CI, 2.70 to 2.77]; 3.98 [CI, 3.93 to 4.03]; and 4.62 [CI, 4.58 to 4.67]). The same model fit to 250 000 black women shows a lesser effect (analogous odds ratios were 1.77 [CI, 1.67 to 1.87]; 2.49 [CI, 2.36 to 2.63]; and 3.15 [CI, 3.04 to 3.25]).
Among older women, mammography is used less often for blacks than for whites. More frequent use of mammography is associated with more visits to a primary care physician in both groups, but the deficit for black women persists at each income level and in each state, even after primary care use is considered. Primary care visits are less likely to "boost" mammography use for black women than for white women.
与白人女性相比，患有乳腺癌的黑人女性5年生存率较低，这可能是因为她们较少进行乳房X光检查。有固定的医疗服务提供者或医疗保健来源是进行乳房X光检查的最重要决定因素。
研究老年黑人女性和老年白人女性在乳房X光检查使用上的差异是否与去看初级保健医生的次数有关。
对来自10个州的1990年医疗保健财务管理局计费文件（医疗保险B部分）进行回顾性审查。
10个州的门诊乳房X光检查服务。
居住在10个州之一的65岁及以上的黑人女性和白人女性。
任何乳房X光检查。预测因素包括种族、去看初级保健医生的次数（0次、1次、2次或3次及以上）、居住邮政编码区域的收入中位数（收入的替代指标）以及州。
以下是来自佐治亚州的研究结果；在每个研究州都发现了类似结果。335680名女性的平均年龄为75岁；20%为黑人。68%的黑人女性和69%的白人女性至少去看过一次初级保健医生。总体而言，14%的女性进行过乳房X光检查；黑人女性进行乳房X光检查的频率低于白人女性（9%对15%）。在每个初级保健就诊水平（1次、2次或3次及以上就诊），黑人女性进行乳房X光检查的频率都低于白人女性（1次就诊，7%对15%；2次就诊，12%对21%；3次及以上就诊，12%对20%）。即使在至少去看过一次初级保健医生的女性中，黑人在每个收入五分位数中都存在差距（最低五分位数，13%对20%；低，10%对18%；中，12%对18%；高，10%对19%；最高，12%对22%），并且在每个州都是如此（例如在佐治亚州，百分比分别为14%对21%）。一个对所有10个州的290万白人女性进行乳房X光检查使用情况预测的年龄、收入和州调整后的逻辑模型显示了初级保健就诊对乳房X光检查的强大影响（1次、2次和3次及以上就诊的比值比分别为2.73 [95%可信区间，2.70至2.77]；3.98 [可信区间，3.93至4.03]；4.62 [可信区间，4.58至4.67]）。对25万黑人女性拟合的同一模型显示影响较小（类似的比值比分别为1.77 [可信区间，1.67至1.87]；2.49 [可信区间，2.36至2.63]；3.15 [可信区间，3.04至3.25]）。
在老年女性中，黑人进行乳房X光检查的频率低于白人。两组中，更频繁地进行乳房X光检查与更多地去看初级保健医生有关，但即使考虑了初级保健就诊情况，黑人女性在每个收入水平和每个州的差距仍然存在。与白人女性相比，初级保健就诊对黑人女性乳房X光检查使用的“促进”作用较小。
