Medicare beneficiaries who live in rural areas undergo mammography screening less than their urban counterparts, according to research published November 13 in Geriatric Nursing.

A team led by Zhaoli Liu, PhD, from the University of Texas at Arlington, found that Hispanic women on Medicare in rural areas are about 33% less likely to regularly undergo screening mammography, while non-Hispanic Black Medicare beneficiaries in rural areas were about 22% less likely to undergo regular screening.

“The findings … highlight the importance of addressing rural racial disparities in mammography utilization among older women to ensure equitable screening practices for all populations,” Liu and colleagues wrote.

Previous studies have demonstrated health disparities in mammography screening in relation to race, ethnicity, and geographic location. However, the researchers noted a lack of data on the interaction of these factors in breast cancer screening.

Liu and co-authors investigated longitudinal patterns in mammography screening practices in relation to rural racial and ethnic disparities within these practices among Medicare beneficiaries. They used Texas Medicare data and assessed the women’s repeat mammography screening behavior every two years from the age of 65 and up to 10 years. The team also explored factors at the individual and county levels tied to long-term adherence to mammography screening practices.

The researchers included data from 114,939 female Medicare beneficiaries between the ages of 65 and 74. They found that women living in rural areas and of unique racial and ethnic populations utilized regular mammography screening less than urban Medicare beneficiaries in these racial-ethnic subpopulations.

Comparison of screening mammography use among Medicare beneficiaries by geographic residency
Rural Urban
White 38.4% 45.3%
Hispanic 21.2% 33.5%
Non-Hispanic Black 33.3% 44.9%

Through stratification analysis, the team also found that rural Hispanic women and rural non-Hispanic Black women were less likely to use mammography screening. This included odds ratios of 0.67 and 0.78, respectively. Rural white women meanwhile had an odds ratio of 1.04, meaning they had 4% higher odds of being screened regularly.

The researchers also found that the lack of a primary care provider, frequent hospitalization, and comorbidity were barriers to receiving regular mammography screening.

The study authors suggested that these disparities and differences in mammography screening practices could be due to the increased diversity in rural populations across the U.S.

“It is worth noting that Texas has the largest rural population [16.3%] and a significant proportion of Hispanic population [40.2%],” they wrote.

The authors also called for targeted and effective mammography screening programs to promote fairness and justice in breast health for minority populations in rural areas.

“Firstly, healthcare professionals must recognize the importance of improving long-term compliance with mammography screening among older women in rural minority populations, a group at the highest risk of breast cancer mortality,” they wrote. “Secondly, efforts to reduce rural racial disparities among older women should not only address barriers related to healthcare access and socioeconomic factors but also consider their general health status, comorbidities, and life expectancy.”

The full study can be found here.