But despite being less likely to report having a usual source of health care, black and Hispanic women are as likely as whites -- or more so -- to receive cervical and breast cancer screening once other factors, such as a regular health-care provider, are considered, a UNC researcher says. For example, black women more often receive Pap smears than whites do.
"We used nationally representative data from the 1996 Medical Expenditure Panel Survey, which was constructed by the Agency for Health Care Research and Quality, for these analyses," said Dr. Giselle Corbie-Smith, assistant professor of both social medicine and medicine. "This involved about 10,000 families in 195 U.S. communities and about 24,000 civilians
"What we found surprised us a bit -- two-directional racial differences in receipt of preventive services. In other words, we found less racial variation between whites and nonwhites in female preventive services than we expected and that some earlier researchers reported."
Not surprisingly, having a usual source of care boosted the chances that any woman would get preventive services, she said. Other factors that affected the likelihood of receiving such screening included education levels, employment and insurance.
"Our study shows that we're doing a better job in targeting women, including blacks and Hispanics, for some preventive services," the physician said. "For the services we looked at the gap between whites and others was large but now it's closing and has disappeared in some cases.
However, this is just the first step.
We still need to work on eliminating the continuing differences in mortality from diseases like breast and cervical cancer between races and ethnic groups."
A report on the findings appears in the June issue of the Journal of General Internal Medicine. Besides Corbie-Smith, authors are Drs. Elaine W. Flagg of the U.S. Centers for Disease Control and Prevention and Emory University physician Joyce P. Doyle and statistician Megan A. O'Brien, also of Emory.
Government and private programs and campaigns that have focused attention on disparities in screening appear to have been responsible for reducing disparities in preventive care and have directed resources toward eliminating them, Corbie-Smith said. Among these have been Healthy People 2000, the new Healthy People 2010 and the National Breast and Cervical Cancer Early Detection Program.
"Since minority women are still dying at higher rates from breast and cervical cancer than non-minority women are, we need to identify those barriers that remain, such as not having resources to obtain care, and eliminate them," she said.
In the new study, she and colleagues found that after controlling for age, education, employment and insurance status, 66 percent of white women who would have been eligible for mammography received it compared with 70 percent of black women and 74 percent of Hispanic women.
After again controlling for those factors, they found 70 percent of eligible white women received Pap smears compared with 83 percent of black women and 78 percent of Hispanics.
Among whites, 79 percent reported having a usual source of care vs. 74 percent of blacks and 60 percent of Hispanics. For mammography, breast exams, blood pressure screening, cholesterol screening and Pap smears, having a usual source of care was the strongest independent predictor of preventive care within each race and ethnic group.
"I think that this work tells us is that, when we are addressing disparities in care, we need to look at every level, not just markers such as receiving a preventive service," Corbie-Smith said. "We also need to make sure that we have policies, resources and systematic ways of addressing the disparities."
The National Heart, Lung and Blood Institute sponsored the study through a Mentored Research Scientist Career Development Award to Corbie-Smith.
Note: Corbie-Smith can be reached at (919) 843-6877.
Contact: David Williamson, (919) 962-8596
Journal
Journal of General Internal Medicine