Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study

Ana M. Progovac, Mary Pettinger, Julie M. Donohue, Chung Chou H.Joyce Chang, Karen A. Matthews, Elizabeth B. Habermann, Lewis H. Kuller, Milagros Rosal, Wenjun Li, Lorena Garcia, Hilary A. Tindle

Research output: Contribution to journalArticle

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Abstract

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.

Original languageEnglish (US)
Pages (from-to)e15869
JournalMedicine
Volume98
Issue number24
DOIs
StatePublished - Jun 1 2019

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Medicare
Longitudinal Studies
Hostility
Women's Health
Social Adjustment
Psychology
Survival
Medicare Part A
Medicare Part B
Patient Acceptance of Health Care
Breast Neoplasms
Delivery of Health Care
Education
Health
Mammography
Risk-Taking
Optimism
Early Detection of Cancer
Uncertainty
Age Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Progovac, A. M., Pettinger, M., Donohue, J. M., Chang, C. C. H. J., Matthews, K. A., Habermann, E. B., ... Tindle, H. A. (2019). Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study. Medicine, 98(24), e15869. https://doi.org/10.1097/MD.0000000000015869

Optimism may moderate screening mammogram frequency in Medicare : A longitudinal study. / Progovac, Ana M.; Pettinger, Mary; Donohue, Julie M.; Chang, Chung Chou H.Joyce; Matthews, Karen A.; Habermann, Elizabeth B.; Kuller, Lewis H.; Rosal, Milagros; Li, Wenjun; Garcia, Lorena; Tindle, Hilary A.

In: Medicine, Vol. 98, No. 24, 01.06.2019, p. e15869.

Research output: Contribution to journalArticle

Progovac, AM, Pettinger, M, Donohue, JM, Chang, CCHJ, Matthews, KA, Habermann, EB, Kuller, LH, Rosal, M, Li, W, Garcia, L & Tindle, HA 2019, 'Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study', Medicine, vol. 98, no. 24, pp. e15869. https://doi.org/10.1097/MD.0000000000015869
Progovac AM, Pettinger M, Donohue JM, Chang CCHJ, Matthews KA, Habermann EB et al. Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study. Medicine. 2019 Jun 1;98(24):e15869. https://doi.org/10.1097/MD.0000000000015869
Progovac, Ana M. ; Pettinger, Mary ; Donohue, Julie M. ; Chang, Chung Chou H.Joyce ; Matthews, Karen A. ; Habermann, Elizabeth B. ; Kuller, Lewis H. ; Rosal, Milagros ; Li, Wenjun ; Garcia, Lorena ; Tindle, Hilary A. / Optimism may moderate screening mammogram frequency in Medicare : A longitudinal study. In: Medicine. 2019 ; Vol. 98, No. 24. pp. e15869.
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abstract = "Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5{\%} more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.",
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