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Women's self-report of mammography use conflicts with verified reports using claims data

National self-report surveys show minimal racial disparity in women's use of mammography to diagnose breast cancer. However, analysis of medical claims data show a large disparity. This may be due to the less accurate nature of women's self-report of mammography, suggests a study supported by the Agency for Healthcare Research and Quality (HS13173). For that reason, the study's authors caution against exclusive reliance on self-report survey data to assess disparity in mammography. They found that elderly women's self-report of mammography was often not verified by medical claims data, thus providing conflicting evidence of disparities in mammography, particularly among black women.

Researchers analyzed 1998-2002 Medicare Current Beneficiary Surveys, which contained elderly women's self-report and medical claims data. They found no racial/ethnic disparities in self-reported mammography; however, verified mammography revealed significant disparities for race, education, income, insurance, and health status. For example, during survey interviews, 52 percent of white, 45 percent of black, and 46 percent of Hispanic women reported having had a mammogram. However, in only 45 percent of white, 29 percent of black, and 31 percent of Hispanic women could those mammograms be verified by Medicare claims data. Black women had a 23 percent lower likelihood of having their mammograms verified than white women.

For both self- and verified-reports, women with less education, lower income, poorer health, and no Medicare supplemental insurance were less likely to have mammograms than their less vulnerable counterparts. There are two potential explanations for these discrepancies between self-report and medical claims, note the researchers. First, they may represent a greater tendency among minority and other vulnerable women to over-report receipt of mammography. Alternatively, they may reflect suboptimal billing by facilities and physicians who provide medical care for greater numbers of minority women.

More details are in "Mammography self-report and mammography claims: Racial, ethnic, and socioeconomic discrepancies among elderly women," by Kathleen Holt, Ph.D., Peter Franks, M.D., Sean Meldrum, M.S., and Kevin Fiscella, M.D., M.P.H., in the June 2006 Medical Care 44(6), pp. 513-518.

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