Research
Reducing disparities in mammography-use in a multicultural population in Israel
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* Corresponding author: Orna Baron-Epel ornaepel@research.haifa.ac.il
1 School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
2 Research and Evaluation Department, Maccabi Healthcare Services, Israel
3 Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Medical Faculty, University of Tel Aviv, Tel Aviv, Israel
4 Faculty of Medicine, Ben Gurion University, Bear Sheba, Israel
International Journal for Equity in Health 2009, 8:19 doi:10.1186/1475-9276-8-19
Published: 19 May 2009Abstract
Background
In the past mammography-use has been reported to be low in Israel compared to other western countries. The objectives of this study were (1) to assess the increase in mammography-use during the years 2002 to 2007 in four population groups in Maccabi Healthcare Services (MHS), Israel: non-immigrant non-ultraorthodox, ultraorthodox, and immigrant Jewish women and Arab women; (2) to assess ethnic and socioeconomic disparities in mammography-use.
Methods
A random telephone survey of 1,550 women receiving healthcare services from MHS was performed during May-June 2007. Information from MHS claims-records database regarding mammography-use was obtained for each woman for the period 2002 to 2007. Since mammography-use serves as a quality assurance measure for primary care, MHS sent mail and telephone invitations for mammography to all women since the end of 2004.
Results
At the beginning of the follow-up period (2002) mammography-use among Jewish non-immigrant non-ultraorthodox and ultraorthodox women was higher than among Arab and Jewish immigrant women. During the 5 year follow-up these disparities decreased significantly. In 2007, mammography-use by Arab women was only slightly lower compared to all groups of Jewish women. In 2007, after adjustment for socioeconomic factors there was only a borderline significant difference between Jewish and Arab women. The socioeconomic variables were not associated with mammography-use in 2002 and 2007 in any of the groups except for marital status in immigrant women in 2002.
Conclusion
The interventions implemented by MHS may have increased mammography-use in all population groups, decreasing disparities between the groups, however the differences between Jewish and Arab women have not been completely eliminated and indicate a need for further targeted interventions. No significant socioeconomic disparities in mammography-use were observed.