4.2.12. Levine Abstract. The role of federal legislation on breast cancer disparities After the Medicare program began to reimburse providers for screening mammography, mortality from breast cancer among US elderly began to fall. However, rates fell more rapidly among whites, and racial disparities widened. Interestingly, disparities did not widen uniformly across the US. We hypothesize that Medicare law inadvertently favors acquisition of screening mammography services by whites since it defines medical assistance as a cash benefit to pay providers regardless of the extent to which cash is the primary barrier to service acquisition. We propose to use the observed geographic variability in mortality disparities to address this hypothesis. We shall obtain large national samples of Medicare data and SEER-linked Medicare claims data to test the following sub-hypotheses: H-l: Regional and state level characteristics will have a significant effect on mammography utilization after adjusting for individual factors. H-2: The effect of regional and state level characteristics on mammography utilization will be different for African American and White women. H-3: The region having the greatest equitability for screening mammography utilization will be more likely to have programs in place aiming to increase mammography utilization and reduce disparities. H-4: Relative to places with moderate to high levels of success, failing places will be more likely to have low survival from breast cancer, and greater percentage increase in racial disparity in survival over time. H-5: Relative to places that are failing or have moderate to high screening mammography utilization, exceptionally successful places will be more likely to have high survival from breast cancer, and to have greater percentage reduction in racial disparity in survival over time. We believe there are compelling reasons to address the proposed hypotheses using alternative means as soon as possible: (a) thousands of deaths from breast cancer among the elderly may have already occurred or will occur because of unintended, adverse effects traceable to Medicare's definition of medical assistance as cash to pay providers;(b) breast cancer may be the tip of the iceberg, particularly with the advent of new programs to provide cash for prescription drugs as part of Medicare;and (c) there may be wider implications as regards the observed declines[2] in US position relative to other industrialized nations for life expectancy and other key measures. The project also proposes reasonable means for obtaining preliminary answers that will be useful for policy makers.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Exploratory Grants (P20)
Project #
5P20MD000516-09
Application #
8401866
Study Section
Special Emphasis Panel (ZRG1-EMNR-B)
Project Start
Project End
2014-11-30
Budget Start
2012-12-01
Budget End
2013-11-30
Support Year
9
Fiscal Year
2013
Total Cost
$100,809
Indirect Cost
$24,753
Name
Meharry Medical College
Department
Type
DUNS #
041438185
City
Nashville
State
TN
Country
United States
Zip Code
37208
Langston, Michael A; Levine, Robert S; Kilbourne, Barbara J et al. (2014) Scalable combinatorial tools for health disparities research. Int J Environ Res Public Health 11:10419-43
Bonuck, Karen; Stuebe, Alison; Barnett, Josephine et al. (2014) Effect of primary care intervention on breastfeeding duration and intensity. Am J Public Health 104 Suppl 1:S119-27
Nestor, Colm E; Barrenäs, Fredrik; Wang, Hui et al. (2014) DNA methylation changes separate allergic patients from healthy controls and may reflect altered CD4+ T-cell population structure. PLoS Genet 10:e1004059
Hull, Pamela C; Reece, Michelle C; Patton, Marian et al. (2014) A community-based oral health self-care intervention for Hispanic families. Int J Public Health 59:61-6
Wang, Kai; Phillips, Charles A; Rogers, Gary L et al. (2014) Differential Shannon entropy and differential coefficient of variation: alternatives and augmentations to differential expression in the search for disease-related genes. Int J Comput Biol Drug Des 7:183-94
Teich, Alice S; Barnett, Josephine; Bonuck, Karen (2014) Women's perceptions of breastfeeding barriers in early postpartum period: a qualitative analysis nested in two randomized controlled trials. Breastfeed Med 9:9-15
Levine, Robert S; Kilbourne, Barbara A; Rust, George S et al. (2014) Social determinants and the classification of disease: descriptive epidemiology of selected socially mediated disease constellations. PLoS One 9:e110271
Goldzweig, Irwin A; Levine, Robert S; Schlundt, David et al. (2013) Improving seat belt use among teen drivers: findings from a service-learning approach. Accid Anal Prev 59:71-5
Chen, Chau-Kuang; Bruce, Michelle; Tyler, Lauren et al. (2013) Analysis of an environmental exposure health questionnaire in a metropolitan minority population utilizing logistic regression and Support Vector Machines. J Health Care Poor Underserved 24:153-71
Goldzweig, Irwin A; Schlundt, David G; Moore, Wayne E et al. (2013) An academic, business, and community alliance to promote evidence-based public health policy: the case of primary seat belt legislation. J Health Care Poor Underserved 24:1364-77

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