Racial disparities in the utilization of preventive health services among older women with early-stage endometrial cancer enrolled in Medicare

Abstract

To assess differences in the receipt of preventive health services by race/ethnicity among older women with endometrial cancer enrolled in Medicare, we conducted a retrospective population-based cohort study of women diagnosed with endometrial cancer from 2001 to 2011 in the Surveillance Epidemiology and End Results (SEER)-Medicare database. Women with stage I or II endometrial cancer of epithelial origin were included. The exposure was race/ethnicity (Non-Hispanic [NH] White, NH Black, Hispanic, and NH Asian/Pacific Islander [PI]). The services examined were receipt of influenza vaccination and screening tests for diabetes mellitus, hyperlipidemia, and breast cancer. We used multivariate logistic regression to estimate odds ratios with 95% confidence intervals (CI) adjusted for age, region, and year of diagnosis. A total of 13,054 women were included. In the 2 years after diagnosis, receipt of any influenza vaccine ranged from 45% among NH Black women to 67% among NH White women; receipt of a mammogram ranged from 65% among NH Black women to 74% among NH White women. Relative to NH White women, NH Black women had a lower likelihood of receiving both influenza vaccination (adjusted odds ratio [aOR] 0.40, 95% CI 0.33-0.44) and screening mammography (aOR 0.64, 95% CI 0.52-0.79). Hispanic women also were less likely to receive influenza vaccination than NH White women (aOR 0.61, 95% CI 0.51-0.72). There were no significant differences across racial groups for diabetes or cholesterol screening services. Among older women with early-stage endometrial cancer, racial disparities exist in the utilization of some preventive services.

Keywords: Cholesterol screening; diabetes mellitus screening; endometrial neoplasms; healthcare disparities; influenza vaccines; mammography; preventive health services; survivors.

Figure 1

Study flow chart.

Figure 2

At least one influenza vaccine within 2 years of diagnosis trends over time.

Figure 3

Two influenza vaccines within 2 years trends over time.

Figure 4

At least one influenza vaccine within 5 years of diagnosis trends over time.

Figure 5

Five influenza vaccines within 5 years trends over time.

Figure 6

At least one mammogram within 2 years of diagnosis trends over time.

Figure 7

Two mammograms within 5 years trends over time.

Figure 8

Diabetes screening test within 5 years of diagnosis trends over time.

Figure 9

Cholesterol screening within 5 years of diagnosis trends over time.