Purpose

Multiple ecological levels influence racial inequities in the completion of diagnostic testing after receiving abnormal mammography results (diagnostic resolution). Yet, few studies examine more than two ecological levels. We investigated the contributions of county, imaging facility, and patient characteristics on our primary and secondary outcomes, the achievement of diagnostic resolution by (1)Black women and Latinas, and (2) the entire sample. We hypothesized that women of color would be less likely to achieve resolution than their White counterparts, and this relationship would be mediated by imaging facility features and moderated by county characteristics.

Methods

Records for 25,144 women with abnormal mammograms between 2011 and 2019 from the Carolina Mammography Registry were merged with publicly available county data. Diagnostic resolution was operationalized as the percentage of women achieving resolution within 60 days of receiving abnormal results and overall time to resolution and examined using mixed effects logistic regression and Cox proportional hazard models, respectively.

Results

Women of color with abnormal screening mammograms were less likely to achieve resolution within 60 days compared with White women (OR 0.83, CI 0.78–0.89; OR 0.74, CI.60–0.91, respectively) and displayed longer resolution times (HR 0.87, CI 0.84–0.91; HR 0.78, CI 0.68–0.89). Residential segregation had a moderating effect, with Black women in more segregated counties being less likely to achieve resolution by 60 days but lost statistical significance after adjustment. No mediators were discovered.

Conclusion

More work is needed to understand how imaging center and community characteristics impact racial inequities in resolution and resolution in general.

中文翻译：

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在解决异常乳房X光检查结果方面造成种族和民族不平等的多层次因素

目的

在收到异常的乳房X光检查结果（诊断解决）后，多个生态水平会影响完成诊断测试的种族不平等。然而，很少有研究考察两个以上的生态水平。我们调查了县、成像设施和患者特征对我们的主要和次要结果的贡献，以及 (1) 黑人女性和拉丁裔女性以及 (2) 整个样本的诊断分辨率的实现。我们假设有色人种女性比白人女性更不可能获得解决方案，并且这种关系将受到成像设施特征的调节并受到县特征的调节。

方法

2011 年至 2019 年间，卡罗莱纳州乳房 X 光检查登记处 25,144 名乳房 X 光检查异常的女性记录已与公开的县数据合并。诊断分辨率可操作为收到异常结果后 60 天内达到分辨率的女性百分比以及分辨率的总时间，并分别使用混合效应逻辑回归和 Cox 比例风险模型进行检查。

结果

与白人女性相比，筛查乳房 X 光检查异常的有色人种女性在 60 天内获得解决的可能性较小（OR 0.83，CI 0.78–0.89；OR 0.74，CI.60–0.91），并且显示解决时间较长（HR 0.87，CI） 0.84–0.91；HR 0.78，CI 0.68–0.89）。居住隔离具有调节作用，种族隔离较多的县的黑人女性在 60 天内解决问题的可能性较小，但调整后失去了统计显着性。没有发现中介者。

结论

需要做更多的工作来了解成像中心和社区特征如何影响分辨率和总体分辨率上的种族不平等。