Disparities In Preventive Care Research Articles

Community-Based Strategies to Reduce Alzheimer's Disease and Related Dementia Incidence Among Rural, Racially/Ethnically Diverse Older Adults.

The purpose of this paper was to address the research question "What recent advances in Alzheimer's Disease and Related Dementias (ADRD) risk reduction strategies can be tailored for rural, racially/ethnically diverse populations?" A rural resident's life story that grounded the work is shared. Next, a brief description is provided regarding ADRD risk factors of importance in rural, multicultural settings. Gaps in U.S.-based research are highlighted. Policy actions and interventions that may make a difference in alleviating rural, ADRD-related disparities are offered. More than a dozen factors, including lack of built environment, periodontitis, poor air quality, and sensory loss, were identified that are of particular relevance to rural groups. Evidence of importance to underserved residents has also emerged regarding the harmful effects of ultra-processed foods on brain health, benefits of even minimal physical activity, and importance of social engagement, on brain health. Resident-led initiatives will be key to creating change at the community level. Health providers are also called to assist in identifying and adapting culturally specific upstream approaches, in partnership with community stakeholders. These mechanisms are vital for decreasing ADRD burdens in underserved communities facing the largest disparities in preventive care.

Abstract P2-11-04: Participation in a breast cancer prevention clinic before and after implementation of the Affordable Care Act

Abstract Background: Secondary prevention can serve to maintain patients’ long-term health and avoid the costs of chronic disease. At the Preventive Care Program for Women’s Cancer Clinic at UAB (UABPC), multidisciplinary staff provide women at increased risk for breast cancer specialized preventive care via comprehensive risk assessment with resultant recommendations for screening and management strategies. In 2011, several provisions of the Affordable Care Act (ACA) eliminated cost sharing of basic women’s preventive screening programs for patients with non-grandfathered health insurance plans. This increased affordability and accessibility of care for millions of Americans and increased awareness of racial disparities in preventive care. In this study, we examined the potential influence of these provisions on increasing total and minority patient participation in specialized preventive services in the UABPC. Methods: Patients seen in this clinic were consented and data was collected to understand use of preventative services. 2003-2011 was designated as the pre-ACA enactment period and 2011-2019 as the post-ACA enactment period. We further subdivided the patient's first participation in the clinic into 4-year periods to more closely assess trends in total and minority patient participation as a function of ACA implementation. Patients’ age, race, first clinic date, and socioeconomic status (SES) were considered for their impact on uptake of services pre- and post-ACA. Results: Between 2003 and 2019, 2,786 patients were entered into this database. The mean age at first visit was 46.28. 84.3% were White, 13.4% were Black and 2.3% were Asian, Hispanic, Native American, Unknown or of other racial origin. 623 (22.36%) patients were first seen during pre-ACA enactment and 2,163 (77.63%) patients were first seen during post-ACA enactment. From 2003-2011, minority patients comprised 6.4% of clinic patients and between 2011-2019 minority clinic patients nearly tripled to comprise 18.6% of all patients seen. We conducted an overall Chi- Square analysis of patients seen in this clinic by race pre- and post-ACA, demonstrating a significant increase in total and minority patients with a p value<.0001. An overall Chi-Square analysis of patients by race among the aforementioned 4-year time-periods also demonstrated a significant increase in patients between 2007-2011 and 2011-2015 with a p value<.0001. A two-sample t-test determined that the decrease in mean age seen between pre- and post-ACA enactment was not statistically significant. Conclusions: We demonstrate a change in overall uptake of our clinic’s preventive services and specifically changes to the racial makeup of the patient population following the implementation of the ACA. The resultant reduced cost sharing for women’s preventive screening and federal advancement of the Offices of Minority Health are plausible factors in the statistically significant increase in awareness of preventive services and increase in total and minority patient enrollment within the UABPC. These meaningful results underscore the value of federal programs focused on decreasing racial disparities in healthcare and increasing access to preventive care for women at increased risk of breast cancer. Future studies will be needed to determine the specific underlying causes and effects to ensure the greatest impact of future policy changes. Pre-ACA (N)Post-ACA (N)Race2003-20072007-20112011-20152015-2019White202381856904Black1424155181Asian, Hispanic, Native American, Unknown or Other022839 Citation Format: Jiliian Tinglin, Andrew Crouse, Helen Krontiras. Participation in a breast cancer prevention clinic before and after implementation of the Affordable Care Act [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-11-04.

Association of Cancer History and Health Care Utilization Among Female Immigrants Using NHANES 2007-2016 Data.

Despite health disparities in preventive care among adult female immigrants, the extent to which their health service utilization is influenced by a cancer history remains largely unknown. Using Andersen's behavioral model, 2007-2016 National Health and Nutrition Examination Survey data were analyzed to examine the influence of a cancer history on health service utilization among adult immigrant women. Multivariate logistic regression models assessed factors related to past year health care utilization, operationalized as an outpatient doctor's visit and an inpatient overnight hospital stay. Once other factors were considered, a past cancer history increased the likelihood of a past year inpatient overnight hospital stay, but was not associated with a past year outpatient doctor's visit. An outpatient doctor's visit for adult female immigrant cancer survivors would provide an opportunity for essential preventive health services. They must be educated about the importance of ongoing outpatient care for cancer surveillance and health maintenance.

Effects of the ACA on Preventive Care Disparities.

The Affordable Care Act (ACA) requires non-grandfathered private insurance plans, starting with plan years on or after September 23rd, 2010, to provide certain preventive care services without any cost sharing in the form of deductibles, copayments or co-insurance. This requirement may affect racial and ethnic disparities in preventive care as it provides the largest copay reduction in preventive care. We ask whether the ACA's free preventive care benefits are associated with a reduction in racial and ethnic disparities in the utilization of four preventive services: cholesterol screenings, colonoscopies, mammograms, and Pap smears. We use a data set of over 6000 individuals from the 2009, 2010, and 2013 Medical Expenditure Panel Surveys (MEPS). We restrict our data set only to individuals who are old enough to be eligible for each preventive service. Our difference-in-differences logistic regression model classifies privately insured Hispanics, African Americans, and Asians as the treatment groups and 2013 as the after-policy year. Our control group consists of non-Hispanic whites on Medicaid as this program already covered preventive care services for free or at a low cost before the ACA. After controlling for income, education, marital status, preferred interview language, self-reported health status, employment, having a usual source of care, age and gender, we find that the ACA is associated with increases in the probability of the median, privately insured Hispanic person to get a colonoscopy by 3.6% and a mammogram by 3.1%, compared to a non-Hispanic white person on Medicaid. Similarly, we find that the median, privately insured African American person's probability of receiving these two preventive services improved by 2.3 and 2.4% compared to a non-Hispanic white person on Medicaid. We do not find any significant improvements for any racial or ethnic group for cholesterol screenings or Pap smears. Furthermore, our results do not indicate any significant changes for Asians compared to non-Hispanic whites in utilizing the four preventive services. These reductions in racial/ethnic disparities are robust to reconfigurations of time periods, previous diagnosis, and residential status. Early effects of the ACA's provision of free preventive care are significant for Hispanics and African Americans. Further research is needed for the later years as more individuals became aware of these benefits.

Wellness Programs With Financial Incentives Through Disparities Lens.

To examine wellness programs with financial incentives and their effect on disparities in preventive care. Financial incentives were introduced by 15 large employers, from 2010 to 2013. Fifteen private employers. A total of 299 436 employees and adult dependents. Preventive services and participation in financial incentives. Multivariate linear regression. Disparities in preventive services widened after introduction of financial incentives. Asians were 3% more likely and African Americans were 3% less likely to receive wellness rewards than whites and non-Hispanics, controlling for other factors. Federal law limits targeting of wellness financial incentives by subgroups; thus, employers should consider outreach and culturally appropriate messaging.

Preventive Service Use Among People With and Without Serious Mental Illnesses.

People with serious mental illnesses experience excess morbidity and premature mortality resulting from preventable conditions. The goal was to examine disparities in preventive care that might account for poor health outcomes. In this retrospective cohort study, adults (N=803,276) served by Kaiser Permanente Northwest and federally qualified health centers/safety-net community health clinics were categorized into five groups: schizophrenia spectrum disorders, bipolar disorders/affective psychoses, anxiety disorders, nonpsychotic unipolar depression, and reference groups with no evidence of these specific mental illnesses. The primary outcome was overall preventive care-gap rate, the proportion of incomplete preventive services for which each patient was eligible in 2012-2013. Secondary analyses examined Kaiser Permanente Northwest data from 2002 to 2013. Data were analyzed in 2015. Controlling for patient characteristics and health services use, Kaiser Permanente Northwest mean care-gap rates were significantly lower for bipolar disorders/affective psychoses (mean=18.6, p<0.001) and depression groups (mean=18.6, p<0.001) compared with the reference group. Schizophrenia (mean=19.4, p=0.236) and anxiety groups (mean=19.9, p=0.060) did not differ from the reference group (mean=20.3). In community health clinics, schizophrenia (mean=34.1, p<0.001), bipolar/affective psychosis (mean=35.7, p<0.001), anxiety (mean=38.5, p<0.001), and depression groups (mean=36.3, p<0.001) had significantly lower care-gap rates than those in the reference group (mean=40.0). Secondary analyses of diabetes and dyslipidemia screening trends in Kaiser Permanente Northwest showed diagnostic groups consistently had fewer care gaps than patients in the reference group. In vastly different settings, individuals with serious mental illnesses received preventive services at equal or better rates than the general population.

Racial and Ethnic Disparities in Preventive Care

Routine health care plays a central role in health promotion and disease prevention for children and in reducing health disparities. The purpose of this study is to examine the prevalence of routine physical examination among racially and ethnically diverse adolescents at 5 different time points. The study used data from the Minnesota Student Survey. Measures include frequency of physical examination by race/ethnicity, poverty status, and family structure. The analytic sample included 351 510 adolescents (1998, n = 67 239; 2001, n = 69 177; 2004, n = 71 084; 2007, n = 72 312; and 2010, n = 71 698). There were significant differences by racial/ethnic group at each time point. For example, in 2010, never having a physical examination was reported by 9.2% American Indian, 8.7% Asian American/Pacific Islander, 7.0% Hispanic/Latino, 4.3% Black/African American, 3.7% mixed race, and 2.6% of White respondents ( P < .001). Patterns of association emerged when the measure of routine physical examination was stratified by poverty and family structure.

Racial/Ethnic Disparities in Preventive Care Practice Among U.S. Nursing Home Residents

To assess racial/ethnic disparities in preventive care practices among U.S. nursing home residents. To implement the Institute of Medicine definition of health care disparity, we used the rank-and-replace adjustment method to assess the disparity in receipt of eight preventive care services among residents and evaluate trends in disparities. The sampling design (stratification and clustering) was accounted for using Stata 11. The 2004 National Nursing Home Surveys data show White residents were more likely to have pain management, scheduled toilet plan/bladder retraining, influenza vaccination, and pneumococcal vaccination than Black residents. White residents were also more likely to have scheduled toilet plan/bladder retraining than residents of Other race/ethnicity. Significant Black-White disparities in receipt of influenza vaccination and pneumococcal vaccination were found. Time trend analysis showed that disparities were neither exacerbated nor reduced. Persistent racial/ethnic disparities in preventive care among nursing home residents exist. We urge the development and implementation of targeted interventions to improve the quality of preventive care in nursing homes.

Obesity Disparities in Preventive Care: Findings From the National Ambulatory Medical Care Survey, 2005–2007

Obesity and its consequences are a major health concern. There are conflicting reports regarding utilization of preventive health-care services among obese patients. Our objective was to determine whether obese patients receive the same preventive care as normal weight patients. Weighted patient clinic visit data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed for all adult patient visits with height/weight data (N = 866,415,856) from 2005 to 2007. Preventive care practice patterns were compared among different weight groups of normal, obese, and morbidly obese. Obese patients received the least number of preventive exams with a clear gradient present by weight. Obese patients were significantly less likely to receive cancer screening including breast examination (normal weight, reference, obese, odds ratio (OR), 0.8), mammogram (obese OR, 0.7), pap smear (obese OR, 0.7), pelvic exam (obese OR, 0.8), and rectal exam (obese OR, 0.7). The obese population also received less tobacco (obese OR, 0.7) and injury prevention education (obese OR, 0.7), yet significantly more diet, exercise, and weight reduction education. Significant differences in clinic practice patterns relative to normal weight patients were also evident with more physician referral (obese OR, 1.2) and less likely to see physician at the index clinic visit (obese OR, 0.8) and less likely to receive psychotherapy referral (obese OR, 0.6). Significant gaps in preventive care exist for the obese including cancer screening, tobacco cessation and injury prevention counseling, and psychological referral. Although obese patients received more weight-related education, this emphasis may have the consequence of de-emphasizing other needed preventive health measures.

The Economic Burden Shouldered by Public and Private Entities as a Consequence of Health Disparities Between Men and Women

On average, American men live shorter, less healthy lives than women. They are more likely to be the victim of a violent crime, die in a car crash, commit suicide, and be injured at work. In addition, men have higher death rates in 9 of the top 10 causes of death, and are less likely to receive routine preventative care, leaving men with a life span that is significantly shorter than women's. Recently, policy makers and researchers have been paying more attention to health disparities including race, sex, and ethnicity. However, men are still noticeably absent from these discussions despite being significantly harmed by disparities in preventive care, quality of life, and overall health outcomes. Ignoring these disparities is costly in terms of lost productivity, lives lost, and financial costs incurred by the government and employers each year. Premature death and morbidity in men costs federal, state, and local governments in excess of $142 billion annually. It also costs U.S.employers and society as a whole in excess of $156 billion annually in direct medical payments and lost productivity and an additional $181 billion annually in decreased quality of life. As federal and state governments and the private sector struggle with increasing health entitlement burdens-including escalating health care costs-eliminating male health inequities emerges as an important source of savings. This analysis will examine the economic and intangible costs associated with the health disparities that exist between genders and the benefits reaped if these disparities are reduced or eliminated.

Disparities in Preventive Care by Body Mass Index Categories Among Women

ABSTRACT Objective: The present analyses examined the relationship of body mass index (BMI) categories to receiving age-appropriate preventive services among women. Method: Data from the Medical Expenditure Panel Survey (2003, N = 10,954) were analyzed using multiple logistic regressions. Outcomes were: age-appropriate Pap-test, mammography, colorectal, cholesterol and blood pressure screening, and influenza immunization. Results: Overall, 3% of participants were underweight, and 26.3% were obese. Obese women were less likely to receive Pap-tests (p < .01), and underweight women less likely to receive mammography (p < .001). Dental care was less likely across all BMI groups outside the normal weight range. Conclusions: The association between BMI categories and preventive services use varied by type of preventive care.

Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States

The causes of racial and ethnic disparities in preventive care are not fully understood. We examined the hypothesis that fewer primary care visits by minority patients contribute to these disparities. We analyzed claims for Medicare beneficiaries 65 and older who participated in the Medicare Current Beneficiary Survey, 1998 to 2002. Five preventive services were included: colorectal cancer testing, influenza vaccination, lipid screening, mammography, and Papanicolaou smear screening. In separate multivariate analyses, we examined the effect of minority status (self-report of African American race or Hispanic ethnicity) on having a claim in the past 12 months for each preventive service after successive control for number of primary care visits and other patient characteristics. The final sample included 15,962 subjects. In age-adjusted analyses, minorities had statistically lower rates of claims for each of the 5 procedures. After controlling for number of primary care visits, the effect of minority status was slightly attenuated but remained statistically significant for receipt of each procedure. After adding low income, low educational level and supplementary insurance, health status, and year, minority status was significantly associated only with colorectal cancer screening (odds ratio [OR] 0.79; 95% confidence interval [CI] 0.67 to 0.94) and influenza vaccinations (OR 0.56; 95% CI 0.49 to 0.64). The frequency of primary care visits seems to contribute minimally to racial and ethnic disparities in preventive services. Other patient characteristics, particularly those associated with poverty, explain much of these disparities.

Perceived Discrimination and Use of Preventive Health Services

Journal of General Internal MedicineVolume 21, Issue 6 p. A‐5-A‐5 Free Access Perceived Discrimination and Use of Preventive Health Services First published: 31 May 2006 https://doi.org/10.1111/j.1525-1497.2006.00413_1.x Address correspondence and reprint requests to Dr. Ayanian: Brigham and Women's Hospital and Harvard Medical School Boston, MA 02115 (e-mail: ayanian@hcp.med.harvard.edu). AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Among nearly 55,000 adults participating in the California Health Interview Survey during 2001, we assessed whether they reported experiencing discrimination in health care during the prior year and whether these perceptions were related to their use of 6 preventive health services for heart disease, diabetes, prostate cancer screening, and flu shots during this time period. Discrimination was reported by about 5% of adults, most often related to their type or lack of insurance, race/ethnicity, or income. Those who reported discrimination were less likely to receive 4 of 6 preventive services. However, perceptions of health care discrimination explained only a small proportion of disparities in preventive care by race, ethnicity, gender, or insurance status. Volume21, Issue6June 2006Pages A‐5-A‐5 RelatedInformation

Do Managed Care Plans Reduce Racial Disparities in Preventive Care?

This study was designed to determine whether managed care plans reduce racial disparities in use of influenza vaccination, mammography, and prostate-specific antigen screening. The study analyzed the use of three types of preventive care in a population-based sample of adults who were 65 years or older and were enrolled in a Medicare managed care (MMC) or fee-for-service (FFS) plan in Allegheny County, Pennsylvania. The study sample included 463 African Americans and 592 whites. Fewer African Americans than whites reported having had an influenza vaccination (64.4% versus 76.5%; p < 0.01) or a prostate-specific antigen test (64% versus 71.2%; p = 0.09) during the previous year. Slightly more African Americans than white women reported having had a mammogram (66.1% versus 63.8%). Logistic regression showed that, regardless of health plan type, African Americans were significantly less likely than whites to have an influenza vaccination (p < 0.05). A MMC plan did not narrow racial differences in preventive care. Reducing disparities may require interventions developed for specific racial/ethnic groups.

Estimating racial/ethnic disparity in mammography rates: it all depends on how you ask the question

Background. Estimates of racial disparity in mammography appear to differ depending on the data source. This study examined the impact of different survey methodology on estimates of racial disparity in mammography. Methods. Responses from 3,090 women ≥40 years to two different questions from the 1996 Medical Expenditure Panel Survey (MEPS) were compared when a mammogram was last obtained versus what medical services, including mammography, were obtained over a 4-month interval, aggregated across 1 year. Results. There was no significant racial disparity in 1-year mammography prevalence based on the first question (white–black difference, 3.3%; 95% confidence interval [CI], −2.5, 9.2). In contrast, a significant disparity in 1-year mammography prevalence was found based on the medical services question (difference, 13.1%; 95% CI 8.6, 17.6). Disparity estimates by Hispanic ethnicity were similar for the two questions: white–Hispanic difference, 1.6%; 95% CI −4.3, 7.5, and white–Hispanic difference 5% (−0.2, 10.1). Adjustment for age, income, and insurance did not alter these findings. Conclusions. Estimates of racial, but not ethnic, disparities in mammography seem to depend on how the question is asked. These results caution against exclusive reliance on annual self-reports for monitoring disparities in preventive care.

Socioeconomic disparities in preventive care persist despite universal coverage. Breast and cervical cancer screening in Ontario and the United States

Socioeconomic disparities in preventive care persist despite universal coverage. Breast and cervical cancer screening in Ontario and the United States