Racial/ethnic disparities in time to follow-up after an abnormal mammogram.

BACKGROUND: Although non-Hispanic white women have an increased risk of developing breast cancer, the disease-specific survival is lower for African American and Hispanic women. Little is known about disparities in follow-up after an abnormal mammogram. The goal of this study was to investigate potential disparities in follow-up after an abnormal mammogram. METHODS: A retrospective cohort study of 6722 women with an abnormal mammogram and documented follow-up from January 2000 through December 2002 was performed at an academic medical center in New York City. The outcome was the number of days between the abnormal mammogram and follow-up imaging or biopsy. Cox proportional hazards models were used to assess the effect of race/ethnicity and other potential covariates. RESULTS: The median number of days to diagnostic follow-up after an abnormal mammogram was greater for African American (20 days) and Hispanic (21 days) women compared with non-Hispanic white (14 days) women (p < 0.001). Racial/ethnic disparities remained significant in a multivariable model controlling for age, Breast Imaging Reporting and Data System (BIRADS) category, insurance status, provider practice location, and median household income. CONCLUSIONS: After an abnormal mammogram, African American and Hispanic women had longer times to diagnostic follow-up compared with non-Hispanic white women. Future efforts will focus on identifying the barriers to follow-up so that effective interventions may be implemented.

Reflections on a decade of experience in implementing a Center for Women's Health at an Academic Medical Center.

On the 10th anniversary of the establishment of a Center for Women's Health (CWH) program, the opportunity to share the successes and limitations in developing a centralized approach to women's healthcare is provided. The development of the CWH at the Columbia University Medical Center, New York-Presbyterian Hospital was prompted by concerns that the health status for women is worse than for men in terms of disability, morbidity, and chronic illness. Moreover, women move through cycles of health and illness differently from men, and gender inequalities in research design and implementation and underrepresentation of women in clinical studies contributed to knowledge gaps concerning women's health, possibly leading to suboptimal care. The goal in developing a program was (1) to provide outstanding medical care to women based on prevention and treatment of unique aspects of women's health, (2) to develop professional training and multidisciplinary educational programs promoting knowledge, understanding, and credible scientific efforts, and (3) to foster collaborative research and communication among researchers, practitioners, policymakers, and organizations. In this paper, the clinical and educational programmatic activities and lessons learned are described.

Race/ethnicity, poverty status, and renal transplant outcomes.

BACKGROUND: There are known racial disparities in renal graft survival. Data are lacking comparing associations of race/ethnicity and socioeconomic status with graft failure and functional status after transplantation. Our goal was to test if African-American and Hispanic race/ethnicity and poverty are associated with worse outcomes following renal transplantation. METHODS: We performed a retrospective cohort study using a nationwide registry (United Network for Organ Sharing). We studied 4,471 adults who received renal transplants in 1990. Outcomes were graft failure and functional status over 10 years. RESULTS: Cumulative incidence of graft failure was higher among African-Americans and Hispanics than whites (77% vs. 64% vs. 60 %; P<0.001) and among transplant recipients living in the poorest areas (70% vs. 58% in the richest; P<0.001). African-American and Hispanic race/ethnicity were independently predictive of graft failure (RR 1.8, 95% CI 1.6-1.9; RR 1.3, 95% CI 1.2-1.6, respectively) in multivariate analyses but poverty status was not (RR 1.0, 95% CI 0.9-1.1). Days with impaired functional status were higher for African-Americans compared to whites (RR 1.6, 95% CI 1.3-1.9) but not independent of poverty. Poverty was independently associated with impaired functional status (RR 1.3, 95% CI 1.0-1.6). CONCLUSIONS: African-Americans and Hispanics had higher rates of graft failure compared to whites after adjustment for poverty and other covariates whereas poverty, but not race/ethnicity, was related to functional status following renal transplantation. National datasets should include individual-level measures of socioeconomic status in order to improve evaluation of social and environmental causes of disparities in renal transplant outcomes.