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Integrating Age and Comorbidity to Assess Screening Mammography Utilization

  • Alai Tan
    Correspondence
    Address correspondence to: Alai Tan, MD, PhD, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Boulevard, Galveston TX 77555-1148
    Affiliations
    Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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  • Yong-Fang Kuo
    Affiliations
    Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas

    Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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  • James S. Goodwin
    Affiliations
    Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas

    Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas

    Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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      Background

      Most studies use age as a cutoff to evaluate screening mammography utilization, generally examining screening up to age 75 years (the age-cutoff method). However, many experts and guidelines encourage clinicians to consider patient health and/or life expectancy.

      Purpose

      To compare the accuracy of estimating screening mammography utilization in older women using the age-cutoff method versus using a method based on the projected life expectancy.

      Methods

      Two cohorts were selected from female Medicare beneficiaries aged 67–90 years living in Texas in 2001 and 2006. The 2001 cohort (n=716,279) was used to generate life-expectancy estimates by age and comorbidity, which were then applied to the 2006 cohort (n=697,825). Screening mammography utilization during 2006–2007 was measured for the 2006 cohort. Data were collected in 2000–2007 and analyzed in 2011.

      Results

      The screening rate was 52.7% in women aged 67–74 years based on age alone, compared to 53.5% in women in the same age group with a life expectancy of ≥7 years. A large proportion (63.4%) of women aged 75–90 years (n=370,583) had a life expectancy of ≥7 years. Those women had a screening rate of 42.7%. The screening rate was 35.7% in women aged 75–90 years based on age alone, compared to 16.3% in women in the same age group with a life expectancy of <5 years.

      Conclusions

      Estimating screening mammography utilization among older women can be improved by using projected life expectancy rather than the age-cutoff method.
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