The role of Federal legislation on breast cancer disparities

4.2.12. 莱文抽象。联邦立法对乳腺癌差异的作用在医疗保险计划开始为乳房x光检查的提供者提供补偿后，美国老年人的乳腺癌死亡率开始下降。然而，白人的死亡率下降得更快，种族差异扩大了。有趣的是，美国各地的差距并没有统一扩大。我们假设，医疗保险法无意中有利于白人获得乳房x光筛查服务，因为它将医疗援助定义为支付提供者的现金福利，而不管现金在多大程度上是获得服务的主要障碍。我们建议使用观察到的死亡率差异的地理变异性来解决这一假设。我们将获得大量的国家医疗保险数据样本和与seer相关的医疗保险索赔数据，以检验以下子假设：H-l：调整个体因素后，地区和州层面的特征将对乳房x光检查的利用产生显著影响。H-2：地区和州层面的特征对非裔美国人和白人妇女乳房x光检查利用的影响是不同的。H-3：乳房x光检查公平性最高的地区将更有可能制定旨在提高乳房x光检查使用率和减少差异的计划。H-4：相对于中等到高度成功的地方，失败的地方更有可能有较低的乳腺癌存活率，并且随着时间的推移，种族差异在存活率上的比例增加更大。H-5：相对于乳房x光检查不合格或有中高筛检的地方

4.2.12. Levine Abstract. The role of federal legislation on breast cancer disparities After the Medicare program began to reimburse providers for screening mammography, mortality from breast cancer among US elderly began to fall. However, rates fell more rapidly among whites, and racial disparities widened. Interestingly, disparities did not widen uniformly across the US. We hypothesize that Medicare law inadvertently favors acquisition of screening mammography services by whites since it defines medical assistance as a cash benefit to pay providers regardless of the extent to which cash is the primary barrier to service acquisition. We propose to use the observed geographic variability in mortality disparities to address this hypothesis. We shall obtain large national samples of Medicare data and SEER-linked Medicare claims data to test the following sub-hypotheses: H-l: Regional and state level characteristics will have a significant effect on mammography utilization after adjusting for individual factors. H-2: The effect of regional and state level characteristics on mammography utilization will be different for African American and White women. H-3: The region having the greatest equitability for screening mammography utilization will be more likely to have programs in place aiming to increase mammography utilization and reduce disparities. H-4: Relative to places with moderate to high levels of success, failing places will be more likely to have low survival from breast cancer, and greater percentage increase in racial disparity in survival over time. H-5: Relative to places that are failing or have moderate to high screening mammography utilization, exceptionally successful places will be more likely to have high survival from breast cancer, and to have greater percentage reduction in racial disparity in survival over time. We believe there are compelling reasons to address the proposed hypotheses using alternative means as soon as possible: (a) thousands of deaths from breast cancer among the elderly may have already occurred or will occur because of unintended, adverse effects traceable to Medicare's definition of medical assistance as cash to pay providers; (b) breast cancer may be the tip of the iceberg, particularly with the advent of new programs to provide cash for prescription drugs as part of Medicare; and (c) there may be wider implications as regards the observed declines[2] in US position relative to other industrialized nations for life expectancy and other key measures. The project also proposes reasonable means for obtaining preliminary answers that will be useful for policy makers.