Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S.
In the U.S., guidelines recommend that women continue mammography screening until at least age 74, but recent evidence suggests declining screening rates in older women. We estimated adherence to screening mammography and multilevel factors associated with adherence in a longitudinal cohort of older women. Women aged 66-75years receiving screening mammography within the Breast Cancer Surveillance Consortium were linked to Medicare claims (2005-2010). Claims data identified baseline adherence, defined as receiving subsequent mammography within approximately 2years, and length of time adherent to guidelines. Characteristics associated with adherence were investigated using logistic and Cox proportional hazards regression models. Analyses were stratified by age to investigate variation in relationships between patient factors and adherence. Among 49,775 women, 89% were adherent at baseline. Among women 66-70years, those with less than a high school education were more likely to be non-adherent at baseline (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.65-2.33) and remain adherent for less time (hazard ratio [HR] 1.41; 95% CI 1.11-1.80) compared to women with a college degree. Women with ≥1 versus no Charlson co-morbidities were more likely to be non-adherent at baseline (OR 1.46; 95% CI 1.31-1.62) and remain adherent for less time (HR 1.44; 95% CI 1.24-1.66). Women aged 71-75 had lower adherence overall, but factors associated with non-adherence were similar. In summary, adherence to guidelines is high among Medicare-enrolled women in the U.S. receiving screening mammography. Efforts are needed to ensure that vulnerable populations attain these same high levels of adherence.
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: rhubb@upenn.edu.
Rebecca A
RA
Hubbard
Group Health Research Institute, Seattle, WA, United States.
Ellen S
ES
O'Meara
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Louise M
LM
Henderson
Department of Internal Medicine and Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM, United States.
Deirdre
D
Hill
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.
Dejana
D
Braithwaite
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.
Jennifer S
JS
Haas
Department of Radiology, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States.
Christoph I
CI
Lee
Department of Surgery, University of Vermont, Burlington, VT, United States.
Brian L
BL
Sprague
Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
Jennifer
J
Alford-Teaster
Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, United States.
Anna N A
ANA
Tosteson
Group Health Research Institute, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States.
Karen J
KJ
Wernli
Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
Tracy
T
Onega
D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007345:Insurance Claim Review; D008137:Longitudinal Studies; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D006278:Medicare; D010349:Patient Compliance; D012959:Socioeconomic Factors; D014481:United States
Adherence; Breast cancer; Mammography; Medicare; Screening