Racial Disparities in the Utilization of Preventive Health Services among Older Women with Early Stage Endometrial Cancer Enrolled in Medicare

Thesis (Master's)--University of Washington, 2016-06

Objective: To assess differences in the receipt of preventive health services by race/ethnicity among older women with endometrial cancer enrolled in Medicare. Methods: 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. Results: 13,054 women were included in this study. In the two years after diagnosis, receipt of any influenza vaccine ranged from 45% among NH Black women to 67% among NH White women; receipt of any 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. Conclusion: Among older US women with early stage endometrial cancer, racial disparities exist in the utilization of some preventive services.