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Effect of Wealth and Prognosis

Brie A. Williams, MD; Karla Lindquist, MS; Rebecca L. Sudore, MD; Kenneth E. Covinsky, MD; Louise C. Walter, MD

Arch Intern Med. 2008;168(5):514-520.

Background  Wealthy women have higher rates of screening mammography than poor women do. Screening mammography is beneficial for women with substantial life expectancies, but women with limited life expectancies are unlikely to benefit. It is unknown whether higher screening rates in wealthy women are due to increased screening in women with substantial life expectancies, limited life expectancies, or both. This study examines the relationship between wealth and screening mammography use in older women according to life expectancy.

Methods  A cohort study was performed of 4222 women 65 years or older with Medicare participating in the 2002 and 2004 Health and Retirement Survey. Women were categorized according to wealth and life expectancy (based on 5-year prognosis from a validated prognostic index). The outcome was self-reported receipt of screening mammography within 2 years.

Results  Overall, within 2 years, 68% of women (2871 of 4222) received a screening mammogram. Screening was associated with wealth (net worth, > $100 000) and good prognosis ( 10% probability of dying in 5 years). Screening mammography was more common among wealthy women than among poor women (net worth, < $10 000) both for women with good prognosis (82% vs 68%; P < .001) and for women with limited prognoses ( 50% probability of dying in 5 years) (48% vs 32%; P = .02). These associations remained after multivariate analysis accounting for age, race, education, proxy report, and rural residence.

Conclusions  Poorer older women with favorable prognoses are at risk of not receiving screening mammography when they are likely to benefit. Wealthier older women with limited prognoses are often screened when they are unlikely to benefit.

Author Affiliations: Division of Geriatrics, University of California, San Francisco (Drs Williams, Sudore, Covinsky, and Walter and Ms Lindquist), and Division of Geriatrics, San Francisco Veterans Affairs Medical Center (Drs Williams, Sudore, Covinsky, and Walter).

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