Race Gap Persists in Health Screening

By January W. Payne
Washington Post Staff Writer
Tuesday, October 17, 2006

Racial and ethnic differences in getting such potentially lifesaving preventive testing as mammograms, Pap smears and colon cancer screenings appear to be larger than previously thought, according to a new study.

While screening gaps between whites and minorities seem to be narrowing in surveys where people state when they last had specific procedures, the reality may be that such gaps are widening or remaining stagnant, suggests the study, which compared such self-reports by a large group of patients against the Medicare claims filed by their doctors.

"Our sense is that probably the claims data are giving us a better picture of the true disparities here in services than in simply asking people whether they've received a preventive service or not," said Kevin Fiscella, the study's lead researcher and an associate professor of family medicine and community and preventive medicine at the University of Rochester School of Medicine. The research, published online in BMC Health Services Research, was funded by the federal Agency for Healthcare Research and Quality.

The study "highlights the importance" of using different types of data -- including insurance claims, self-reports and medical charts and records -- to get a accurate picture of disparities, said Ernest Moy, a senior service fellow at AHRQ who did not take part in the study.

The research was prompted by other surveys indicating that black women were getting mammograms nearly as often as white women; such data suggested that efforts to reduce this disparity have paid off. Yet racial gaps in breast cancer mortality rates persist, Fiscella said.

"That made us wonder, 'Is this [other] data really accurate?' " he said. "And if so, why are [black women] dying and being diagnosed at later stages?" There are many explanations, he said, "including that the [self-reported] data may not be accurate."

The health-care community should take heed of the new study's results, advised Jessie Gruman, president of the Center for the Advancement of Health, a group that encourages adoption of effective medical practices.

"I think it's very important for the health-care system and for individual providers to be very clear about their expectations" of patients, she said. "People need the information" about recommended testing well in advance of when the test is due, "and getting the test needs to be facilitated for them."

In the study, Medicare participants were asked to recall whether they'd had certain preventive services in the preceding year. Those responses were then verified against Medicare claims data.

The study looked at more than 7,000 patients eligible for prostate cancer screening, 18,300 eligible for flu shots, 4,700 eligible for Pap smears, 10,400 eligible for cholesterol testing, 7,400 eligible for mammograms and 1,400 eligible to be screened for colorectal cancer.

Respondents were 65 and older. Most were white, with minorities representing 9 to 13 percent of each test group.

Previous research shows that people often underestimate how much time has passed since they received preventive care, according to the study.

The study found that 52.5 percent of whites who were eligible for a mammogram reported having had one in the previous year, while claims data showed 45.1 percent had actually received the test. About 45 percent of eligible non-white Hispanic and African American women reported having had mammograms, yet claims data showed only 30.4 percent had had the test done.

Further research needs to be done to see why these differences exist.

"We think there's more social pressure on minorities [to report having been screened] because the inaccurate stereotype is that minorities don't care about their health like whites do," Fiscella said. "And so when a [minority] person answers that question, they are answering in the context of existing social stereotypes, [and there is] more pressure to say, 'I'm not like that. Of course I take care of my health.' "

But patients' self-reports aren't the only issue in tracking the delivery of preventive services. Minorities are more likely than other people to use community health centers and hospital clinics, which often underestimate the volume of screening they provide, the study states. ยท

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