title: Black-white disparities in elderly breast cancer mortality before and after implementation of Medicare benefits for screening mammography.
abstract: BACKGROUND
  Medicare implemented reimbursement for screening mammography in 1991.
  
  
  RESULTS
  Post-implementation, breast cancer mortality declined faster (p< .0001) among White than among Black elderly women (65+ years). No excess breast cancer deaths occurred among Black elderly compared with White elderly through 1990; over 2,459 have occurred since. Contextual socioeconomic status does not explain differences between counties with lowest Black breast cancer mortality/post-implementation declines in disparity and counties with highest Black breast cancer mortality/widened disparity post-implementation.
  
  
  CONCLUSIONS
  The results lead to these hypotheses: (a) Medicare mammography reimbursement was causally associated with declines in elderly mortality and widened elderly Black:White disparity from breast cancer; (b) the latter reflects inherent Black-White differences in risk of breast cancer death; place-specific, unaddressed inequalities in capacity to use Medicare benefits; and/or other factors; (c) previous observations linking poverty with disparities in breast cancer mortality are partly confounded by factors explained by theories of human capability and diffusion of innovation.
authors.affiliation: Department of Family and Community Medicine at Meharry Medical College, Nashville, TN, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Levine
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Kilbourne
authors.forename: Peter A
authors.initials: PA
authors.lastname: Baltrus
authors.forename: Shanita
authors.initials: S
authors.lastname: Williams-Brown
authors.forename: Lee
authors.initials: L
authors.lastname: Caplan
authors.forename: Nathaniel C
authors.initials: NC
authors.lastname: Briggs
authors.forename: Kimyona
authors.initials: K
authors.lastname: Roberts
authors.forename: Baqar A
authors.initials: BA
authors.lastname: Husaini
authors.forename: George E
authors.initials: GE
authors.lastname: Rust
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States; D044465:White People