Regardless of Income, American Indian/Native American Women May Be Less Likely to Undergo Mammography Than White Women

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Investigators found that American Indian/Native American women living in higher-income communities did not have a higher mammography uptake compared with American Indian/Native American women living in lower-income communities, according to a new study published by Christensen et al in the American Journal of Preventive Medicine.

Study Methods and Results

In the new study, the investigators evaluated 457,476 Medicare fee-for-service beneficiaries—and found that the racial/ethnic gap in the annual mammography uptake rate between White women and American Indian/Native American women narrowed between 2005 and 2019. While this narrowed gap represented a smaller disparity, the change was driven by a decline in mammograms among White women, not an increase among American Indian/Native American women.

The findings also demonstrated that White women living in higher-income communities were 31% more likely to have mammograms than White women living in lower-income communities. Further Asian, Hispanic, and Black women were 16% more likely to have mammograms if they lived in higher-income communities than in lower-income communities.

“Not surprisingly, we found that American Indian/Native American women were 13% less likely overall to have a mammogram than White women,” explained lead study author Eric Christensen, PhD, Adjunct Professor of Health Services Management at the University of Minnesota and Director of Economics and Health Services Research at the Harvey L. Neiman Health Policy Institute. “However, it was surprising that American Indian/Native American women residing in higher-income communities were no more likely to receive [mammograms] than American Indian/Native American women residing in lower-income communities. That mammography [uptake] does not increase with income is remarkable, because racial disparities typically diminish with higher income,” he added.


“Our results show that we should not assume that income will have the same impact on mammography across racial/ethnic groups,” noted Bhavika Patel, MD, Associate Professor of Radiology and a diagnostic radiologist in the Department of Radiology at the Mayo Clinic. “The literature shows that among American Indian/Native American women, cultural factors—such as comfort discussing [mammograms] and connection to their native culture—may exert more influence on mammography [uptake] than income alone. Hence, policies to improve mammography [uptake] need to be specifically tailored to American Indian/Native American women,” she stressed.

“Our study also estimated the share of women with any [mammogram] over the study period rather than just the annual screening rate,” stated Elizabeth Rula, PhD, Executive Director of the Harvey L. Neiman Health Policy Institute. “This was revealing as we were able to follow the women in our study for 7.7 years, on average. Across all years, 62% of women did not have any [mammograms]. This result indicates the need for more emphasis on increasing the reach of screenings rather than just improving adherence to the recommended screening cadence,” she concluded.

The investigators emphasized the need for new policies designed to reduce the disparities in mammography uptake between American Indian/Native American women and White women.

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