| Mammography is an accepted secondary prevention tool for detecting breast cancer, the second leading cause of cancer deaths among women. Although Medicare began covering screening mammography in 1991, its use among older women is not without controversy and there is a lack of uniform guidelines. Understanding the factors associated with mammography among older women, therefore, is important from a clinical and policy perspective.; This dissertation used a comprehensive array of demographic, socioeconomic, and health-related variables to examine mammography among Medicare beneficiaries in the Asset and Health Dynamics Among the Oldest Old study. Progressive model building using multivariable logistic and multinomial regression was performed and several sensitivity analyses were conducted. The research objectives included: to determine the prevalence of mammography based on self-reports and claims information, assess the concordance between self-reported mammography and Medicare claims, identify the characteristics associated with concordance, and determine the risk factors associated with mammography among older women.; The prevalence of self-reported mammography (54%) was twice the prevalence of mammography identified from Medicare claims data (27%). The concordance between self-reported and claims-based mammography use was poor; African Americans and women on Medicaid had significantly lower odds of concordance, primarily due to overreporting. Based on claims data, continuity of care was the factor most strongly associated with mammography use and this finding was extensively explored. Women with at least a high school education, with 2 or more children, and women who participated in regular vigorous activity also were more likely to have had a mammogram. The odds of receiving screening mammography decreased with a woman's age and were lower for women with a decline in self-rated health. Although income and wealth were not independently associated with mammography use, self-expectations about future financial position were.; The study of mammography among older women will continue to be an essential research agenda because of increases in life expectancy and health-related quality of life improvements, advances in imaging and therapies, controversy regarding the efficacy and cost-effectiveness of mammography, and Medicare policies to subsidize these services. |
