Mammography Use: RESULTS

10 Oct
2009

Of the 1,103 households randomly selected, we identified 392 eligible women. Among the eligible women, 329 completed the questionnaires (response rate=84%). Forty-three percent (n=144) of the interviewed respondents described their ethnicity as Haitian, 24% (n=80) white, 17% (n=56) African-American, 8% (n=26) English-speaking Caribbean, 7% (n=22) as Latina, and the remainder (n=3, <2%) as other ethnic identity. For the purpose of analysis, we excluded women in this last category, leaving 326 for analysis.


Table 1 shows the demographic characteristics of the 326 subjects. Caribbean and white women were significantly older than other groups of women (two sample t-tests, pO.OOl). Haitian respondents (62%) were less likely to complete high school than all others interviewed (two sample t-tests, p=0.001). More Haitian women (63%) but fewer Caribbean women (35%) were married (p=0.03). Fifty-seven percent of the respondents were employed on either a full- or part-time basis, and employment status did not vary by ethnicity (p=0.81). Sixty-one percent had private health insurance. Health insurance status did not differ by ethnicity (p=0.13). Most women (93%) reported that they had a regular healthcare provider (p=0.31). Haitian women immigrants spent less time in the United States compared to other immigrant women (median length of stay 14 years compared to 17 years for English-speaking Caribbean and 22 years for Latina). Two Haitian women, none of the Latina and none of the English-speaking Caribbean women were born in the United States. viagra plus

Table 1. Demographic Characteristics by Ethnicity of Community-Based Sample in Eastern Massachusetts (n=326)

Haitian N=143White N=80African-American N=55N(%)Caribbean N=26Latina N=22

P Value

Age

40-49

50-59

60-69

70+

60 (43) 42 (32) 28 (20) 10(7)24 (31) 16 (20)19        (24)

20        (25)

28 (52) 16 (30) 4(7) 6(11)6(24) 8 (32) 5(20) 6(24)13 (59) 5(23) 4(18) 0

<0.01

Education <High school87 (62)7(9)10 (19)13(54)8 (36)

<0.01

Marital Status Married87 (63)37 (46)29 (55)9(35)10 (45)

0.03

Employment Status Employed84 (59)41 (52)32 (59)14 (56)14 (64)

0.81

Insurance Status

Private

Public

None

71 (51) 40 (29) 28 (20)47 (59) 29 (36) 4(5)30 (56) 18 (33) 6(11)14 (54) 8(31) 4(15)11 (52) 9(43) 1 (5)

0.13

Have regular provider

127 (91)74 (96)49 (91)25 (96)22 (100)

0.31

Age mean (SD)*

53.1 (10.8)58.8 (13.7)52.0 (11.0)59.0 (11.2)49.9 (8.0)

O.01

* SD Standard Deviation

The prevalence of ever having had a mammogram among respondents was high (84%). Haitian women (82%) reported “ever” mammography use similar to that of African-American (78%), Caribbean (81%) and Latina women (86%) (Table 2). There was a nonsignificant trend of white women having a higher rate of ever having had a mammogram (94%, p=0.10). The overall prevalence of having had a mammogram in the past two years was also high (69%) and similar. Women with a regular healthcare provider reported a high prevalence of both ever (87% vs. 64%;p=0.004) and recent mammography (73% vs. 37%;p=0.001) compared to women without a regularprovider. Women with a greater knowledge about breast cancer (Femara canadian is a type of hormonal therapy that is used in the treatment of breast cancer) were more likely to have ever had a mammogram (88% vs. 72%; p=0.002) and to have had one in the past two years (72% vs. 59%; p=0.04), compared to those with less knowledge. Insurance, age, education, marital and employment status were not related to ever or recent mammography in bivariate analyses. Scales measuring modesty, fatalism and efficacy were also not statistically associated with mammography use.
Table 2. Unadjusted Prevalence of Ever Had a Mammogram and Mammogram in the Past Two Years by Ethnicity and Selected Demographic Variables

Variables

Ever Had a Mammogram N (%)       [P Value]

Had a Mammogram in the Past Two Years N (%)           [P Value]

Ethnicity Haitian (N=143) White (N=80) African-American (N=55) Caribbean (N=26) Latina (N=22)118 (82%) 75 (94%) 43 (78%) 21 (81%) 19 (86%)[O.10]96 (67%) 53 (66 %) 39 (71 %) 21 (81 %) 18 (82 %)

[0.41]

Age Category40-49

50-59

60-69

70+

114 (80%) 80 (90%) 41 (83%) 35 (90%)[0.44]97 (68%) 69 (76%) 31 (67%) 26 (69%)

[0.43]

Education <High school >High school108 (86%) 162 (84%)[0.48]89 (71%) 133 (69%)

[0.62]

Marital Status Married Not married149 (87%) 124 (84%)[0.47]121 (70%) 104 (70%)

[0.81]

Employment Status Employed

161 (87%)

[0.26]

137 (74%)

[0.08]

Unemployed

113 (83%)

89 (65%)

Insurance StatusPrivate

Public

None

150 (87%) 87 (84%) 35 (81%)[0.61]130 (75%) 68 (65%) 27 (63%)

[0.12]

Have Regular ProviderYes

No

257 (87%) 14 (64%)[<0.01]

217 (73%) 8 (37%)

[O.01]

Knowledge about Breast Cancer (Treating breast cancer) More                                 226 (88%) Less                                   50 (72%)[<0.01]186 (72%) 41 (59%)

[0.04]

Breast ModestyMore

Less

19 (79%) 250 (85%)[0.44]13 (54%) 208 (71%)

[0.09]

Fatalism on CancerMoreLess39 (76%) 237 (86%)[0.08]32 (63%) 195 (71%)

[0.24]

Efficacy of Preventive MedicineMore                                230 (83%)

Less                                   48 (92%)

[0.12]190 (69%) 37 (74%)

[0.47]

Significant differences by ethnicity were found in women’s beliefs concerning cancer prevention and treatment. On a 0-5 scale, with highest scores measuring greater fatalistic attitudes, Caribbean (1.52) and Haitian (1.51) women showed more fatalistic attitudes towards cancer prevention and treatment than white (0.82) and African-American women (0.87) (overall Chi-square p=0.0005). No significant ethnic differences were found on breast modesty (p=0.81) or efficacy of mammogram screening (p=0.90). However, none of these belief measures were associated with ever or recent mammography uses.
Table 3. Unadjusted Odds Ratios of Ever Had a Mammogram and Had a Mammogram in the Past Two Years*

Ever Had a Mammogram

Had a Mammogram in the Past Two Years

OR (95% CI)

OR (95% CI)
Ethnicity
Haitian                                   0.23 (0.075-0.69)

1.18 (0.56-2.49

African-American                     0.25 (0.66-0.97)

1.94 (0.65-5.75)

Caribbean                             0.32 (0.12-0.88)

1.08 (0.6-1.93)

Latina                                   0.42 (0.093-1.93

2.29 (0.71-7.44)

White                                            1.0

1.0

The unadjusted odds ratio was calculated using bivariate logistic regression (i.e. with only ethnicity in the model.

The unadjusted odds ratios are presented in Table 3. In multivariate logistic regression, where ethnicity was forced into the model, Haitian and African-American women had a 70% less odds of ever having had a mammogram (OR=0.3; 95% CI, 0.1-0.9) as compared to white women. However, ethnicity was not a predictor of having had a mammography in the past two years (Table 4). Having a regular provider, knowledge about breast cancer (Arimidex 1mg is used to treat breast cancer), education and private insurance were associated with mammography use (Table 4). Women with a regular provider had a 3.4 times increased odds of ever having had a mammogram, compared to those with no regular provider (95% CI, 1.1-10.1), and 3.4 times increased odds of having had a mammogram in the past two years (95% CI, 1.3-9.1). Women with knowledge about breast cancer (Methotrexate tabletes is used to treat certain types of cancer of the breast) had increased odds of ever having a mammogram (OR 2.8; 95% CI 1.3-6.1), and having had one in the past two years (OR 1.9; 95% CI 1.0-3.4). Education remained a significant predictor of ever having had a mammogram: subjects with high-school education or greater had an odds ratio of 3.4 for having ever had a mammogram, as compared to women with a less-than-high-school education (95% CI, 1.5-7.9). Education was not a significant predictor of having had a mammogram in the past two years. Women with private insurance were 2.4 times more likely to ever have had a mammogram (95% CI, 1.2-5.0), and 1.7 more likely to have had a mammogram in the past two years (95% CI, 1.1-3.0) than those with public insurance.
Table 4. Adjusted Odds Ratios of Ever Had a Mammogram and Had a Mammogram in the Past Two Years*

Ethnicity HaitianAfrican- American

Caribbean

Latina

White

Ever Had a Mammogram Adjusted OR (95% CI)0.3 (0.1-0.9) 0.3 (0.1-0.9) 0.2 (0.1-1.0) 0.3 (0.1-1.4) 1.0 (reference)Had a Mammogram in the Past Two Years Adjusted OR (95% CI)1.3 (0.7-2.6)

1.1                                    (0.5-2.7)

2.2                                (0.7 – 6.9)

2.7 (0.7- 10.2)

1.0 (reference)

Have a Regular Provider Yes3.4 (1.1 – 10.1)3.4 (1.3-9.1)
Knowledge about Breast CancerMore                                     2.8(1.3-6.1)1.9(1.0-3.4)
Education High school3.4(1.5 -7.9)
Insurance None Private Public2.2 (0.3-19.7) 2.4 (1.1 -5.0) 1.0 (reference)4.6 (0.5 – 39.4) 1.7 (1.1 -3.0) 1.0 (reference)

C-statistic

0.740.66
Odds ratios were calculated by stepwise logistic regression. Ethnicity was forced in the model. Age, education, marital status, fatalistic attitude on, breast modesty, and efficacy, length of stay in the US were rejected by in the multivariate model.
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