Abstract 14764: Underuse of Preventive Care Among Female Sudden Death Victims

Abstract

Background: Sudden death accounts for approximately 10% of deaths among working age adults. The rate of sudden death among females is one third lower than males, although the burden of chronic medical conditions are similar in victims of both sexes. The reasons for this difference are unclear and may be important in addressing preventive screening underutilization, as preventive screenings have been shown to reduce morbidity and mortality. Research Questions: Does utilization of preventive services differ among sudden death victims and living controls? Do these differences vary by sex? Aims: We aim to describe receipt of preventive screenings and influenza vaccination in sudden death victims and to compare these rates to those of a living control population. Methods: Clinical records from 267 out-of-hospital sudden death victims aged 18-64 in Wake County, North Carolina from 2013-2015 and 1112 demographically matched living controls from the same county and time were compared. Victims were identified by screening Emergency Medical Service records and adjudicated to exclude expected deaths from chronic disease, trauma, suicide, and overdose. Records were systematically reviewed for evidence of influenza vaccination and receipt of colon, cervical, and breast cancer screenings within the past five years, according to USPSTF criteria. Percentage of individuals who received each preventive screening were compared using means difference tests. Binomial regression was performed to investigate the effect of insurance status on preventive care receipt Results: Rates of colonoscopy and influenza vaccination were similar between cases and controls among both sexes. Female victims had low utilization of preventive services and were less likely to have received Pap smears (24.1% vs 50.9%; p<0.001) and mammography (44.0% vs 65.2%; p<0.001) compared to controls. While these differences can be partially explained by insurance status, with both private and public insurance being protective, screening differences remained significant. Conclusion: Significant differences in preventive screenings are present among female sudden death victims and may represent an important behavioral pattern to identify and intervene upon in these vulnerable patients.