ACCESS TO MAMMOGRAPHY FOR OLDER WOMEN OF COLOR

老年有色人种女性乳腺癌死亡风险升高 (2.2黑人比白人多一倍），这主要是由于 在诊断阶段的种族差异。乳腺X线摄影依从性 对于那些风险最高的女性来说，指南的风险最低。改进 每年可以防止成千上万的乳腺癌死亡， 但对于老年妇女的具体影响知之甚少， 与少数群体地位有关的文化因素和障碍。特别是， 社会人口变量和结构变量之间的相互关系 没有充分考虑造成不遵守的因素， 研究了这项研究旨在评估相对 影响乳房X光检查的三个独立领域的贡献 利用：个人决策和资源，提供者转介 行为和机构准入。乳腺X线摄影的横断面调查 在有色人种妇女的帮助下， 健康联盟，并在急诊科（艾德）进行试点， 波士顿市立医院（Boston City Hospital），一家附属于波士顿的市内公立医院。 大学医学院。面对面的采访遵循十一 调查健康信念，人口统计学因素， 文化适应程度、定期护理来源、获得其他类型的 预防性保健和乳房X光检查使用模式。组 与年龄和人种/种族相关的差异将在 对50岁以上妇女进行大规模多族裔抽样 到艾德接受治疗。Multinomial Logit将用于 比较3组：1）从未进行过乳房X线摄影; 2）既往进行过乳房X线摄影; 3） 最近的乳房X光检查将使用嵌套Logit来证明 两个相关但不相关的不同变量的相对重要性 相同的决定：基线乳房X光检查和定期遵守。 医疗保险B部分的乳房X光检查利用率、健康 还将调查居住在农村地区妇女的状况和提供者类型， 在与调查受访者相同的邮政编码地区，使用类似的分析， 技术和自我报告的准确性乳房X线摄影估计。结果 这将有助于确定政策方向。如果健康信念和信息 是乳房X光检查使用的主要决定因素， 私人的努力可以针对发展创新， 文化能力的教育外展计划。如果职业 转诊是遵守乳房X光检查的关键，那么资金应该 针对专业培训、协议和指南，以及 质量监控如果首要问题是获得医疗保健， 需要在机构和国家决策层面进行变革。 为了实现2000年健康人的目标，必须确定明确的优先事项 减少不必要的乳腺癌死亡。

Older women of color experience an elevated breast cancer mortality risk (2.2 times greater for blacks than whites) that is primarily the result of racial disparities in stage of diagnosis. Adherence to mammography guidelines is lowest for those women at highest risk. Improved utilization could prevent thousands of breast cancer deaths each year, but little is known about the specific effects among older women of cultural factors and barriers related to minority status. In particular, interrelationships among sociodemographic variables and structural factors responsible for non-compliance have not been adequately investigated. This study was designed to assess the relative contributions of three separate domains that affect mammography utilization: individual decision-making and resources, provider referral behavior, and institutional access. A cross-section survey of mammography behaviors has been developed with assistance from Women of Color Coalition for Health and piloted in the Emergency Department (ED) at Boston City Hospital, a public inner-city hospital affiliated with Boston University School of Medicine. Face-to-face interviews follow an eleven question format that investigates health beliefs, demographic factors, level of acculturation, regular source of care, access to other types of preventive health care and mammography utilization patterns. Group differences related to age and race/ethnicity will be assessed in a large, multi-ethnic sample of women greater than 50 years of age presenting to the ED for medical care. Multinomial Logit will be used to compare 3 groups: 1) no mammography ever; 2) past mammography; and 3) recent mammography. Nested Logit will be utilized to demonstrate the relative importance of different variables for two related but not identical decisions: baseline mammography and regular compliance. Medicare Part B claims-level data for mammography utilization, health status and provider type will also be investigated among women residing in the same zip code areas as survey respondents, using similar analysis techniques, and accuracy of self-report of mammography estimated. Results will help establish policy direction. If health beliefs and information are the principal determinants of mammography utilization, both public and private efforts can be targeted toward developing innovative, culturally competent educational outreach programs. If professional referrals are key to mammography compliance, then funds should be directed toward professional training, protocols and guidelines, and quality monitoring. If the primary problem is access to health care, changes will be required at institutional and state policymaking levels. Clear priorities must be set in order to meet the Healthy People 2000 goal of reducing needless breast cancer death.