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The mission of the Harvey L. Neiman Health Policy Institute® is to establish foundational evidence for health policy and radiology practice that promotes the effective and efficient use of health care resources and improves patient care.

March 2, 2023

American Indian/Native American Women have Lower Mammography Use Even if they have Higher Income

Reston, VA – A new Harvey L. Neiman Health Policy Institute study found that for American Indian/Native American women, living in above-average-income communities was not associated with higher mammography use compared to American Indian/Native American women living in below-average-income communities. The study, published in the American Journal of Preventive Medicine, found that for White women, those in above-average-income communities were 31% more likely to have mammography than White women in below-average-income communities. The women of other race (Asian, Black, Hispanic, or other) were 16% more likely to have a mammogram if they lived in above-average-income community.

“Not surprisingly, we found that American Indian/Native American women were 13% less likely overall to have a mammogram than White women,” said Eric Christensen, PhD, Research Director at the Neiman Institute and lead author of the study. “However, it was surprising that American Indian/Native American women residing in high-income communities were no more likely to receive mammography than American Indian/Native American women residing in low-income communities. That mammography use does not increase with income is remarkable because racial disparities typically diminish with higher income.”

“Our results show that we should not assume that income will have the same impact on mammography across racial/ethnic groups,” explained Bhavika Patel, MD, diagnostic radiologist at Mayo Clinic. “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 study was based on an evaluation of 457,476 Medicare fee-for-service beneficiaries residing in Arizona, California, New Mexico, Oklahoma, or Washington during the 2005-2019 period. In this data set, the researchers found that the racial/ethnicity gap in the annual mammography rate between White women and American Indian/Native American women narrowed between 2005 and 2019. While this narrowed gap represents a smaller disparity, unfortunately, the change was driven by a decline in mammography use among White women, not an increase among American Indian/Native American women.

“Our study also estimated the share of women with any mammography over the study period rather than just the annual screening rate,” stated Elizabeth Rula, PhD, Executive Director of the Neiman Institute. “This was revealing as we were able to follow the women in our study for 7.7 years, on average. Across all years, nearly two-thirds (62%) of women did not have any mammography. This result indicates the need for more emphasis on increasing the reach of screening rather than just improving adherence to the recommended screening cadence.”


To obtain a copy of the study or to arrange an interview with a spokesperson, contact Nichole Gay at



About the Harvey L. Neiman Health Policy Institute

The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at and follow us on TwitterLinkedIn and Facebook.



Nichole Gay
Harvey L. Neiman Health Policy Institute