• Dongyu Zhang, Linn Abraham, Brian L Sprague, Tracy Onega, Shailesh Advani, Joshua Demb, Diana L Miglioretti, Louise M Henderson, Karen J Wernli, Louise C Walter, Karla Kerlikowske, John T Schousboe, Elizabeth Chrischilles, Dejana Braithwaite, Ellen S O'Meara, and Breast Cancer Surveillance Consortium.
• Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States of America; University of Florida Health Cancer Center, Gainesville, FL, United States of America.
• Prev Med. 2022 Jan 1; 154: 106869106869.

AbstractPrior studies of screening mammography patterns by functional status in older women show inconsistent results. We used Breast Cancer Surveillance Consortium-Medicare linked data (1999-2014) to investigate the association of functional limitations with adherence to screening mammography in 145,478 women aged 66-74 years. Functional limitation was represented by a claims-based function-related indicator (FRI) score which incorporated 16 items reflecting functional status. Baseline adherence was defined as mammography utilization 9-30 months after the index screening mammography. Longitudinal adherence was examined among women adherent at baseline and defined as time from the index mammography to end of the first 30-month gap in mammography. Multivariable logistic regression and Cox proportional hazards models were used to investigate baseline and longitudinal adherence, respectively. Subgroup analyses were conducted by age (66-70 vs. 71-74 years). Overall, 69.6% of participants had no substantial functional limitation (FRI score 0), 23.5% had some substantial limitations (FRI score 1), and 6.8% had serious limitations (FRI score ≥ 2). Mean age at baseline was 68.5 years (SD = 2.6), 85.3% of participants were white, and 77.1% were adherent to screening mammography at baseline. Women with a higher FRI score were more likely to be non-adherent at baseline (FRI ≥ 2 vs. 0: aOR = 1.13, 95% CI = 1.06, 1.20, p-trend < 0.01). Similarly, a higher FRI score was associated with longitudinal non-adherence (FRI ≥ 2 vs. 0: aHR = 1.16, 95% CI = 1.11, 1.22, p-trend < 0.01). Effect measures of FRI did not differ substantially by age categories. Older women with a higher burden of functional limitations are less likely to be adherent to screening mammography recommendations.Copyright © 2021 Elsevier Inc. All rights reserved.

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