title: A multilevel study of socioeconomic predictors of regular mammography use among African-American women.
abstract: BACKGROUND
  Little is known about the predictors of adherence to mammography guidelines by African-American women. We assessed individual-level and group-level socioeconomic predictors of regular mammography use in a large cohort of African-American women.
  
  
  METHODS
  We included 14,706 participants in the Black Women's Health Study who were 40 to 69 years of age at baseline in 1995. Data were obtained through mail questionnaires at entry and biennially during three 2-year follow-up periods until 2001. We linked the women's addresses to census block (neighborhood) socioeconomic data. With multilevel multivariable regression analysis, we assessed the relation of individual-level and neighborhood socioeconomic factors to "regular" mammography use (use in all three follow-up periods) relative to nonregular use, with control for other predictors.
  
  
  RESULTS
  Most participants had health insurance and almost half had graduated college. Having health insurance was the socioeconomic variable most strongly associated with regular mammography use (odds ratio, 3.59; 95% confidence interval 3.02-4.28); the association was present at all levels of educational attainment, household income, and neighborhood socioeconomic status. Regular mammography use increased with individual household income: odds ratio, 2.00 (95% confidence interval, 1.58-2.53) for household income > USD $100,000 relative to < USD $15,001. Regular mammography use did not vary across level of education. Higher neighborhood socioeconomic status was significantly associated with regular mammography use before, but not after, control for household income.
  
  
  CONCLUSIONS
  Access to health insurance is strongly associated with regular mammography use among African-American women, even at higher levels of educational attainment and socioeconomic status. Neighborhood socioeconomic characteristics do not materially influence regular use.
authors.affiliation: Slone Epidemiology Center, Boston University, 1010 Commonwealth Avenue, Boston, MA 02215, USA. lrosenberg@slone.bu.edu
authors.forename: Lynn
authors.initials: L
authors.lastname: Rosenberg
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Wise
authors.forename: Julie R
authors.initials: JR
authors.lastname: Palmer
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Horton
authors.forename: Lucile L
authors.initials: LL
authors.lastname: Adams-Campbell
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D015331:Cohort Studies; D004493:Education; D005260:Female; D005544:Forecasting; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D007348:Insurance, Health; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D010349:Patient Compliance; D012923:Social Class