Investigating reversals of association for utilization of recent mammography among Hispanic and Non-Hispanic Black women

Cancer Causes Control. 2009 Oct;20(8):1483-95. doi: 10.1007/s10552-009-9345-8. Epub 2009 Apr 26.


Objective: Several papers have found that Hispanic and Non-Hispanic Black women have higher adjusted odds ratios for recent mammography when compared with Non-Hispanic White women, even though their crude percentages were lower than, or about equal to, Non-Hispanic White women's. This paper investigates the existence of "reversals" of association for recent mammography and describes an analysis strategy for identifying variables that might produce them.

Methods: We used every-other-year data for women aged 40-80 from the 1996-2006 Behavioral Risk Factor Surveillance System and the 1999, 2000, 2003, and 2005 National Health Interview Survey. A consistent set of covariates was used across all datasets.

Results: Reversals were found in almost all survey years for Hispanic women. Non-Hispanic Black women often had unadjusted rates comparable to Non-Hispanic Whites, but their adjusted odds ratios were significantly higher in most surveys. A limited number of variables contributed strongly to reversals, and differed somewhat for Hispanic and Black women.

Conclusions: Reversed associations found in adjusted analyses present a challenge for interpretation, but could also denote success of programs to increase screening rates. Users of population-level surveys should be alert for reversals and attempt to find explanations.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Behavioral Risk Factor Surveillance System
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / ethnology
  • Female
  • Health Behavior
  • Health Services Accessibility
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Periodicity
  • Socioeconomic Factors
  • Time Factors