Reducing Health Disparities Through Prevention: Role of the U.S. Preventive Services Task Force

Abstract

In 1984, the U.S. Preventive Services Task Force (USPSTF) was founded to create evidence-based recommendations guiding the use of diverse preventive services, including screening tests, behavioral interventions, and medications. Recommendations from this independent expert group are widely followed, and in some cases have produced substantial changes in clinical practice. One example, prostate cancer screening with prostate-specific antigen, was routinely performed among middle-aged and elderly men for decades until the USPSTF 2012 recommendation against this practice.1 Like prostate cancer, many diseases that are the subject of their preventive service recommendations disproportionately affect racial/ethnic minorities. This highlights a unique opportunity for USPSTF’s recommendations to reduce health disparities. The USPSTF follows a rigorous, transparent, and dynamic process for reviewing existing evidence and developing its recommendations.2 Using commissioned systematic literature reviews, the USPSTF considers the quality of evidence supporting each preventive service, and the magnitude of net benefit from implementing it. These reviews assess the certainty of the existing evidence, in addition to the magnitude of benefits and harms associated with the service. This process is intended to “maximize population health benefits while minimizing harms.”3 Weighing the potential impacts of preventive service recommendations from a population perspective may help achieve the greatest benefit for the largest number of Americans. However, some subpopulations may derive more benefit or experience greater harm from certain preventive services. If there is insufficient evidence to recommend a preventive service in the entire population, it is unlikely that the same service will benefit high-risk groups such as racial/ethnic minorities. However, it is possible that racial/ethnic differences in benefits and harms of recommended services or differential implementation of those services by race/ethnicity could widen health disparities in some groups. The USPSTF currently addresses high-risk subgroups in several ways.4 Most recommendations target specific groups defined by a limited number of risk factors, such as individuals’ age, sex, and specific exposures like smoking. The USPSTF also targets high-risk subgroups defined by numerous risk factors that are captured in multivariate risk models, like the 2016 statin recommendation,5 which require a calculation to determine eligibility. Although some risk models include race/ethnicity, none of the current USPTSF recommendations use race/ethnicity as a deciding factor.