The Effect of Two Church-based Interventions on Breast Cancer Screening Rates Among Medicaid-Insured Latinas

INTRODUCTION: Latinas face disparities in cancer screening rates compared with non-Latina whites. The Tepeyac Project aims to reduce these disparities by using a church-based approach to increase breast cancer screening among Latinas in Colorado. The objective of this study was to compare the effect of two Tepeyac Project interventions on the mammogram rates of Latinas and non-Latina whites enrolled in the Medicaid fee-for-service program. METHODS: Two intervention groups were compared: 209 churches in Colorado that received educational printed materials in Spanish and English (the printed statewide intervention) and four churches in the Denver area that received personalized education from promotoras, or peer counselors (the promotora intervention), in addition to the printed statewide intervention. Biennial Medicaid mammogram claim rates in Colorado before the interventions (1998–1999) and after (2000–2001) were used to compare the effect of the interventions on mammogram use among Latinas and non-Latina whites aged 50 to 64 years who were enrolled in the Medicaid fee-for-service program. Adjusted rates were computed using generalized estimating equations. RESULTS: Small, nonsignificant increases in screening were observed among Latinas exposed to the promotora intervention (from 25% at baseline to 30% at follow-up [P = .30]) as compared with 45% at baseline and 43% at follow-up for the printed statewide intervention (P = .27). Screening among non-Latina whites increased by 6% in the promotora intervention area (from 32% at baseline to 38% at follow-up [P = .40]) and by 3% in the printed statewide intervention (from 41% at baseline to 44% at follow-up [P = .02]). No significant disparities in breast cancer screening were detected between Latinas and non-Latina whites. After adjustment for the confounders by generalized estimating equations, the promotora intervention had a marginally greater impact than the printed statewide intervention in increasing mammogram use among Latinas (generalized estimating equation, P = .07). CONCLUSION: A personalized community-based education was only modestly effective in increasing breast cancer screening among Medicaid-insured Latinas. Education alone may not be the answer for this population. The barriers for these Medicaid enrollees must be investigated so that interventions can be tailored to address their needs

The Contribution of Cancer Incidence, Stage at Diagnosis and Survival to Racial Differences in Years of Life Expectancy

African Americans have higher cancer mortality rates than whites. Understanding the relative contribution of cancer incidence, stage at diagnosis and survival after diagnosis to the racial gap in life expectancy has important implications for directing future health disparity interventions toward cancer prevention, screening and treatment. We estimated the degree to which higher cancer mortality among African Americans is due to higher incidence rates, later stage at diagnosis or worse survival after diagnosis. Stochastic model of cancer incidence and survival after diagnosis. Surveillance and Epidemiology End Result cancer registry and National Health Interview Survey data. Life expectancy if African Americans had the same cancer incidence, stage and survival after diagnosis as white adults. African-American men and women live 1.47 and 0.91 fewer years, respectively, than whites as the result of all cancers combined. Among men, racial differences in cancer incidence, stage at diagnosis and survival after diagnosis account for 1.12 (95% CI: 0.52 to 1.36), 0.17 (95% CI: −0.03 to 0.33) and 0.21 (95% CI: 0.05 to 0.34) years of the racial gap in life expectancy, respectively. Among women, incidence, stage and survival after diagnosis account for 0.41 (95% CI: −0.29 to 0.60), 0.26 (95% CI: −0.06 to 0.40) and 0.31 (95% CI: 0.05 to 0.40) years, respectively. Differences in stage had a smaller impact on the life expectancy gap compared with the impact of incidence. Differences in cancer survival after diagnosis had a significant impact for only two cancers—breast (0.14 years; 95% CI: 0.05 to 0.16) and prostate (0.05 years; 95% CI 0.01 to 0.09). In addition to breast and colorectal cancer screening, national efforts to reduce disparities in life expectancy should also target cancer prevention, perhaps through smoking cessation, and differences in survival after diagnosis among persons with breast and prostate cancer

A simulation model approach to analysis of the business case for eliminating health care disparities

<p>Abstract</p> <p>Background</p> <p>Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers.</p> <p>Methods</p> <p>To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers) and indirect (absenteeism, productivity) effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma.</p> <p>Results</p> <p>The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity) combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately$1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%.</p> <p>Conclusions</p> <p>For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates.</p

Inverted papilloma of the ureter.

The inverted urothelial papilloma described herein is the fourth case developing in the ureter. The association with a well-differentiated conventional papilloma of the renal pelvis is the noteworthy feature of this case