Screening Mammography and Pap Tests Among Older American Women 1996–2000: Results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD)

Truls Østbye; Gary N. Greenberg; Donald H. Taylor; Ann Marie M. Lee

doi:10.1370/afm.54

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Figure 1.
Mammography: proportion (weighted) reported screening in the last 2 years, by age-group and year.
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Figure 2.
Cervical cancer: proportion (weighted) reported screening in the last 2 years, by age-group and year.

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Table 1.

Receipt of Preventive Services by Survey Wave in Selected Subgroups (Weighted Percentages)

	HRS				AHEAD
	Pap Test		Mammogram		Pap Test		Mammogram
Variables	1996n=4,370	2000n=4,854	1996n=4,370	2000n=4,854	1995n=3,818	2000n=3,040	1995n=3,818	2000n=3,040
Pap = Papanicolaou; HRS = Health and Retirement Study; AHEAD = Asset and Health Dynamics Among the Oldest Old.
* Income categories: HRS – 1996: 1, ≤ $13,000; 2, $13,001-$31,600; 3, $31,601-$58,269; 4, > $58,269. 2000: 1, ≤ $8,295; 2, $8,296-$20,420; 3, $20,421-$49,504; 4, >$49,504. AHEAD – 1995: 1, ≤ $10,560; 2, $10,561-$18,000; 3, $18,001-$30,000; 4, > $30,000. 2000: 1, ≤ $8,400; 2, $8,401-$12,000; 3, $12,001-$18,840; 4, > $18,840.
† Subjective life expectation: HRS: “(What is the percent chance) that you will live to be 75 or more?” AHEAD: “(Using a number from 0 to 100) what do you think are the chances that you will live another 5 years?”
Demographic
Age, years
50–54	74	74	72	79	–	–	–	–
55–59	69	73	72	76	–	–	–	–
60–64	63	70	71	78	–	–	–	–
70–74	–	–	–	–	54	57	65	77
75–79	–	–	–	–	44	47	59	65
80–84	–	–	–	–	31	36	43	54
85–89	–	–	–	–	23	25	37	42
White	68	70	72	77	42	43	54	62
Black	68	70	73	78	47	44	57	58
Socioeconomic
Completed high school	71	72	76	80	46	48	61	68
Not completed high school	57	60	60	69	35	35	44	49
Born in the United States	68	70	72	77	42	44	54	62
Born abroad	70	68	71	77	38	43	50	61
Married	71	73	75	81	49	52	64	71
Not married	61	63	64	70	38	38	48	56
Income category*
1	58	65	59	73	35	34	44	49
2	65	64	69	73	42	41	54	58
3	70	69	76	77	44	47	58	67
4	80	80	85	87	50	51	63	71
Health
Smokers	57	58	60	64	41	36	51	52
Non smokers	71	72	75	81	42	44	54	62
Less physical activity	–	66	–	75	–	40	–	58
Vigorous exercise	–	74	–	80	–	52	–	70
Health excellent, very good, good	70	72	73	79	45	46	56	64
Health poor or fair	60	63	66	72	36	38	50	57
Cognitively normal	–	–	–	–	44	44	57	64
Cognitively impaired	–	–	–	–	34	40	40	48
Subjective life expectation^†
0%–33%	61	64	65	73	37	36	48	54
34%–66%	64	69	70	77	48	49	63	68
67%–100%	73	74	75	81	49	50	60	67
Health care
Uninsured	46	49	44	52	–	–	–	–
Insured	71	71	75	80	–	–	–	–
No additional private insurance	–	–	–	–	37	43	45	62
Additional private insurance	–	–	–	–	43	61	57	74
Not in hospital last year	68	70	71	77	43	44	54	62
Hospitalized in the last year	64	66	73	78	39	42	53	61
0–2 physician visits last year	59	57	59	63	41	33	50	47
3–5 physician visits last year	73	75	78	82	44	44	56	62
6+ physician visits last year	72	74	78	82	42	46	57	66

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Table 2.

Adjusted Relative Odds of Receipt of Cancer Screening Services: Health and Retirement Study (HRS) Multivariate Models

Variables	Pap TestFull ModelOR (95% CI)(n = 10,146)*	MammogramFull ModelOR (95% CI)(n = 10,156)*
Pap = Papanicolaou; OR = odds ratio; CI = confidence interval.
* Number of observations in model. Most women contributed 2 observations: 1996 and 2000. A total of 5,942 answered at least 1 survey question once.
† Reference categories: year = 1996; age = 50–54.9 years; race = white.
‡ Reference categories: education = not completed high school; birth place = born abroad; marital status = not married; income = category 4 (see footnote to Table 1).
§ Reference categories: smoking status = not smoking; exercise = less physical activity; health = excellent, very good, or good; subjective life expectations = 0%–33% (see footnote to Table 1).
\|\| Reference categories: health insurance = some health insurance; hospitalization in last year = not in hospital last year; physician visits in last year = 0–2 visits in last year.
Demographic^‡
Year 2000	0.96 (0.88–1.05)	1.22 (1.11–1.35)
Age 55–59.9 years	0.97 (0.87–1.08)	1.17 (1.04–1.31)
Age 60–64.9 years	0.87 (0.78–0.97)	1.18 (1.05–1.33)
Black	1.38 (1.22–1.56)	1.37 (1.20–1.57)
Socioeconomic^‡
Completed high school	1.25 (1.13–1.40)	1.26 (1.12–1.41)
Born in the United States	0.86 (0.74–1.00)	0.80 (0.68–0.94)
Married	1.22 (1.10–1.35)	1.30 (1.17–1.45)
Income category 1	0.63 (0.55–0.73)	0.55 (0.47–0.65)
Income category 2	0.60 (0.52–0.68)	0.58 (0.50–0.67)
Income category 3	0.69 (0.60–0.79)	0.64 (0.55–0.74)
Health^§
Smoking	0.70 (0.63–0.77)	0.58 (0.52–0.65)
Vigorous exercise	1.25 (1.14–1.37)	1.12 (1.01–1.23)
Poor or fair health	0.77 (0.69–0.87)	0.80 (0.70–0.91)
Subjective life expectation 34%–66%	1.03 (0.91–1.16)	1.03 (0.90–1.17)
Subjective life expectation 67%–100%	1.28 (1.14–1.44)	1.15 (1.01–1.23)
Health care^\|\|
Uninsured	0.53 (0.46–0.61)	0.38 (0.34–0.44)
In hospital in last year	0.88 (0.78–1.00)	0.98 (0.85–1.13)
3–5 physician visits in last year	1.90 (1.68–2.13)	2.15 (1.90–2.43)
6+ physician visits in last year*	2.11 (1.89–2.36)	2.54 (2.26–2.86)

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Table 3.

Adjusted Relative Odds of Receipt of Cancer Screening Services: Asset and Health Dynamics Among the Oldest Old (AHDEAD) Multivariate Models

Variables	Pap TestFull ModelOR (95% CI)(n = 6,330)*	MammogramFull ModelOR (95% CI)(n = 6,347)*
Pap = Papanicolaou; OR = odds ratio; CI = confidence interval.
* Number of observations in model – most women contributed 2 observations: 1995 and 2000. A total of 4,543 women answered at least 1 survey question once.
† Reference categories: year = 1995; age = 70–74.9 years; race = white.
‡ Reference categories: education = not completed high school; birth place = born abroad; marital status = not married; income = category 4 (see footnote to Table 1).
§ Reference categories: smoking status = not smoking; exercise = less physical activity; health = excellent–very good–or good; mental status = cognitively normal; subjective life expectation = 0%–33% (see footnote to Table 1).
\|\| Reference categories: health insurance = no other private insurance; hospitalization in last year = not in hospital last year; physician visits in last year = 0–2 physicians in last year.
Demographic ^†
Year 2000	0.91 (0.76–1.09)	1.11 (0.93–1.33)
Age 75–79.9 years	0.84 (0.74–0.96)	0.93 (0.81–1.06)
Age 80–84.9 years	0.54 (0.46–0.63)	0.61 (0.52–0.71)
Age 85–89.9 years	0.41 (0.33–0.51)	0.46 (0.37–0.56)
Black	1.58 (1.34–1.87)	1.57 (1.40–1.78)
Socioeconomic ^‡
Completed high school	1.37 (1.22–1.55)	1.58 (1.40–1.78)
Born in the United States	0.83 (0.69–1.01)	0.67 (0.55–0.81)
Married	1.32 (1.17–1.48)	1.30 (1.15–1.47)
Income category 1	0.77 (0.65–0.90)	0.64 (0.54–0.75)
Income category 2	0.82 (0.70–0.95)	0.74 (0.63–0.87)
Income category 3	0.88 (0.76–1.02)	0.91 (0.78–1.07)
Health ^§
Smoking	0.77 (0.64–0.94)	0.74 (0.61–0.90)
Vigorous exercise	1.36 (1.21–1.53)	1.32 (1.16–1.49)
Poor or fair health	0.79 (0.70–0.89)	0.91 (0.80–1.03)
Cognitive impairment	0.97 (0.79–1.18)	0.73 (0.60–0.88)
Subjective life expectation 34%–66%	1.11 (0.98–1.27)	1.26 (1.11–1.44)
Subjective life expectation 67%–100%	1.13 (0.99–1.28)	1.10 (0.97–1.27)
Health care ^\|\|
Additional private insurance	1.20 (1.01–1.44)	1.31 (1.10–1.57)
In hospital in last year	1.00 (0.88–1.14)	0.97 (0.85–1.10)
3–5 physician visits in the last year	1.43 (1.24–1.65)	1.63 (1.41–1.88)
6+ physician visits in the last year	1.61 (1.39–1.85)	2.01 (1.74–2.32)