Providers may need to try different tactics to address breast imaging disparities among American Indian women, according to a new Neiman Health Policy Institute study published Wednesday.

The gap in mammography use between this population and white women has actually narrowed over the past decade. However, more nuanced work is needed to further address inequities, experts wrote in the American Journal of Preventive Medicine [1].

For instance, household earnings do not have the same influence on outcomes among American Indians as other populations, according to national trends data.

“Our results show that we should not assume that income will have the same impact on mammography across racial/ethnic groups,” study co-author Bhavika Patel, MD, a diagnostic radiologist at the Mayo Clinic, said in a statement. “The literature shows that, among American Indian/Native American women, cultural factors, such as comfort discussing mammography and connection to their native culture, may exert more influence on mammography use than income alone. Hence, policies to improve mammography use need to be specifically tailored to American Indian/Native American women.”

The retrospective analysis used data from a 5% representative sample of fee-for-service Medicare beneficiaries residing across Arizona, California, New Mexico, Oklahoma and Washington. Altogether, the study included more than 457,000 women at an average age of 68, with outcomes spanning from 2005 to 2019. The makeup included more than 78% white women, 1.5% American Indian and 20% “other.”

During the study period, adjusted mammography use declined from about 205 per 1,000 women in the first year to 165 per 1,000 by 2019. The slope of this drop appeared much steeper for white women (-3.06) vs. American Indian individuals (-0.65). Meanwhile, the odds of using mammography were lower for the latter in both urban and rural settings. Residing in a higher-income community had zero influence among American Indian women, the authors added, but the rate was 31% higher for their white counterparts.

“That mammography use does not increase with income is remarkable because racial disparities typically diminish with higher income,” study lead author and Neiman Institute Research Director Eric Christensen, PhD, said in a statement.