title: Integrating age and comorbidity to assess screening mammography utilization.
abstract: BACKGROUND
  Most studies use age as a cutoff to evaluate screening mammography utilization, generally examining screening up to age 75 years (the age-cutoff method). However, many experts and guidelines encourage clinicians to consider patient health and/or life expectancy.
  
  
  OBJECTIVE
  To compare the accuracy of estimating screening mammography utilization in older women using the age-cutoff method versus using a method based on the projected life expectancy.
  
  
  METHODS
  Two cohorts were selected from female Medicare beneficiaries aged 67-90 years living in Texas in 2001 and 2006. The 2001 cohort (n=716,279) was used to generate life-expectancy estimates by age and comorbidity, which were then applied to the 2006 cohort (n=697,825). Screening mammography utilization during 2006-2007 was measured for the 2006 cohort. Data were collected in 2000-2007 and analyzed in 2011.
  
  
  RESULTS
  The screening rate was 52.7% in women aged 67-74 years based on age alone, compared to 53.5% in women in the same age group with a life expectancy of ≥7 years. A large proportion (63.4%) of women aged 75-90 years (n=370,583) had a life expectancy of ≥7 years. Those women had a screening rate of 42.7%. The screening rate was 35.7% in women aged 75-90 years based on age alone, compared to 16.3% in women in the same age group with a life expectancy of <5 years.
  
  
  CONCLUSIONS
  Estimating screening mammography utilization among older women can be improved by using projected life expectancy rather than the age-cutoff method.
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas 77555-1148, USA. altan@utmb.edu
authors.forename: Alai
authors.initials: A
authors.lastname: Tan
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008327:Mammography / Q000379:methods* / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D006278:Medicare; D017410:Practice Guidelines as Topic; D014481:United States