Abstract MP57: Universal and Targeted Lipid Screening in Youth Living With Overweight or Obesity

Abstract

Background: Current NHLBI Expert Panel guidelines recommend universal screening once between 9-11 years and, again, between 17-21 years. Targeted screening is recommended for 2 years and older with a) obesity, or b) overweight AND personal or family history of obesity-related co-morbidities. The present study compares compliance with current lipid screening guidelines by race/ethnicity and socioeconomic status (SES). Methods: Using electronic health record data for n=300,776 youth between 2 and 17 years of age from Kaiser Permanente Southern California and a BMI-for-age >=85 th percentile, HR for the ordering of a lipid screening according to the current guidelines were calculated for both, universal screening and targeted screening at any age for children living with obesity with and without comorbid conditions such as diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD) and adjusted for age, sex, BMI-for-age class (overweight, moderate obesity between 95 th and 1.2 x 95 th percentile, obesity >= 1.2 x 95 th percentile of BMI-for-age), and comorbid conditions (diabetes, hypertension, and NAFLD). Results: The average age of the cohort was 8.6 (SD 5.7) years with 49.4% Hispanic, 25.0% White, 7.3% Black, and 9.3% Asian/Pacific Islander youth, 19.8% with state-subsidized insurance. Of these, 13.2 of youth lived with obesity between 95 th and 1.2 x 95 th percentile, and 5.2% >= 1.2 x 95 th percentile of BMI-for-age. For 43.1% of youth, a universal lipid screening was ordered as recommended. The aHR for universal screening was 1.23 (1.21-1.26) for Hispanic, 1.15 (1.11-1.19) for Black, 1.27 (1.23, 1.31) for Asian/PI youth compared to white youth, 1.05 (1.03-1.07) for youth with state-subsidized insurance compared to those without. Among youth living with obesity, targeted screening was ordered as recommended for 38.1% of youth with 23.8%, 68.1%, and 61.6% for 2-8, 9-17, and 15-17 year olds respectively. The aHR for targeted screening was 1.58 (1.58-1.61) for youth living with obesity >= 1.2 x 95 th percentile of BMI-for-age compared to those between 95 th and 1.2 x 95 th percentile, 1.08 (1.06-1.10) for youth with state-subsidized insurance compared to those without, 1.57 (1.49-1.65) for youth with diabetes, and 1.11 (1.04-1.20) for youth with NAFLD compared to those without. The aHR for targeted screening did not vary by race/ethnicity. Conclusions: In this integrated health care system, universal and targeted screening missed about 50% of youth living with overweight or obesity. While universal screening rates were higher for minority youth and lower SES, targeted screening rates were driven by obesity severity and comorbid conditions than race or SES.