Routine checkups don’t ensure that seniors get preventive services

The Journal of Family Practice. 2011 January;60(1):E1-E10

January 1, 2011|Family Medicine

Julie Bolen, PhD, MPH;Douglas Shenson, MD, MPH, MS

Less than half of those 65 years or older are “up to date” with minimal preventive services despite regular checkups.

Statistical analysis
We conducted statistical analysis using Stata, version 9.0 (Stata Corp; College Station, Tex). We used Pearson chi-square tests to determine whether selected demographic factors were associated with being up to date on all recommended services. We also used Stata in a logistic regression analysis to control simultaneously for age, education, race/ethnicity, marital status, insurance coverage, health care access, having one or more personal health care providers, having a routine checkup within 2 years, current smoking, and health status. We computed odds ratios and 95% confidence intervals for each variable in the model.

Results

FAST TRACK

Although most adults ages 65 and older had high access to health care and recent routine checkups, only about 45% of men and 37% of women were up to date with recommended preventive services.

Most adults ages 65 years and older were fully insured, had a personal health care provider, and reported no cost barrier to seeing a doctor in the past year (TABLE 1). Breaking out these measures into 3 levels of relative health care access, 88.6% of men and 90.2% of women were at the highest level. More than 90% of respondents reported having a routine checkup in the past 2 years. More than 60% reported receiving each of the separate immunizations and cancer screenings recommended for their age and sex, and almost all had received at least 1 service.

TABLE 2 shows the prevalence of being up to date by demographic group. Only 42.6% of all older men and 35.2% of all older women were up to date, with rates marginally better for those with high access to care (45.1% for men, 37% for women) or those reporting a recent routine checkup (44.8% for men, 36.8% for women). Low access to care yielded dramatically worse up-to-date rates (14.8% for men, 9.1% for women). Similarly, those reporting no recent routine checkup had poor up-to-date rates (20.5% for men, 15.4% for women). The highest rates of being up to date belonged to those with a college degree (49% for men, 42.1% for women). Higher rates were also found among the oldest age groups.

Results of the logistic regression analysis are shown in TABLE 3. Among men and women, being up to date was more likely for those who were older, married, better educated, had high access to health care, and had had a routine checkup in the past 2 years. The latter 2 groups had the highest odds ratios of all groups in the model. Less likely to be up to date were those who were Black, Hispanic, or of a race other than white, those who smoked cigarettes, and (for men) those who were in good or better health. For women, health status had no effect on being up to date.

Table 1
Characteristics of US adults ≥65 years, 2006 Behavioral Risk Factor Surveillance System

	Men		Women
	Percent	n	Percent	n
Total	100	32,243	100	58,762
Age (y)
65-69	30.7	10,286	27.1	16,184
70-74	25.8	8410	21.2	14,005
75-79	22.9	6685	24.6	12,562
≥80	20.7	6862	27.1	16,011
Race/ethnicity
White	81.7	27,720	81.5	50,270
Black	7.3	1631	8.0	3656
Hispanic	6.0	931	6.4	1824
Other*	5.0	1423	4.2	2218
Education
< High school	15.0	5010	17.6	9931
High school	29.3	9905	39.0	22,978
Some college	20.9	6552	23.6	14,372
College grad	34.9	10,664	19.7	11,226
Married	74.0	20,593	44.5	20,551
Insurance
Fully insured	94.2	30,147	94.0	55,066
Underinsured^†	3.5	1173	4.3	2385
Not insured	2.3	754	1.7	993
Has a personal health care provider	93.1	29,657	95.3	55,586
No cost barrier	96.2	30,838	95.4	56,021
Health care access^‡
Low	1.4	450	0.9	561
Medium	10.0	3521	8.8	5271
High	88.6	27,996	90.2	52,430
Fair/poor health	27.6	8957	29.7	16,727
Clinical preventive services
Flu shot past year	68.3	21,725	67.0	39,205
Pneumococcal polysaccharide vaccine	63.6	19,531	66.7	38,442
Colon cancer screen	71.3	21,395	67.9	37,112
Pap test in 3 years (women with cervix)			70.8	19,700
Pap test in 3 years (credit for hysterectomy)			84.8	46,943
Mammogram in 2 years			79.1	43,874
Number of health care services received
0	9.6	2993	3.0	1615
1	19.3	5335	5.0	2659
2	28.5	8085	10.9	5679
3^§	42.6	12,506	19.2	10,108
4			26.8	13,935
5^§			35.2	18,471
Total^\|\|	100	28,919	100.0	52,467
Routine checkup^¶	91.5	28,845	93.1	53,037
Includes American Indian, Asian, Pacific Islander, and individuals of other or multiple race categories. ^†Underinsurance includes individuals with coverage who indicated there was a time in the past year when they needed to see a doctor but could not due to cost (cost barrier). ^‡Determined from 3 measures: having health insurance, having a personal health care provider, and not* reporting a cost barrier. Levels 0 and 1 were combined. Resulting levels were low, medium, and high. ^§To be up to date, men required colon cancer screening (fecal occult blood test in past year or endoscopy within 10 years), a flu shot in the past year, and a pneumonia vaccination ever. Women required those same services plus a mammogram within 2 years and Pap test within 3 years (unless prior hysterectomy). ^\|\|Total n excludes 3324 men and 6295 women with missing values for one or more tests. ^¶Respondents who indicated they had a routine “checkup” in the past 2 years.

Table 2
Prevalence of being up to date* by demographic characteristics, US adults ≥65 years, 2006 Behavioral Risk Factor Surveillance System

	Men		Women
	Percent	95% CI	Percent	95% CI
Total	42.6	41.6-43.7	35.2	34.4-36.0
Age (y)
65-69	32.0	30.3-33.7	29.8	28.4-31.3
70-74	44.9	42.7-47.2	39.1	37.5-40.8
75-79	48.7	46.2-51.2	40.2	38.5-41.9
≥80	48.9	46.5-51.2	32.9	31.4-34.5
P value	<.0001		<.0001
Race/ethnicity
White	46.2	45.1-47.3	37.9	37.1-38.7
Black	27.8	23.7-32.3	22.4	19.7-25.4
Hispanic	20.8	15.7-27.0	22.1	17.7-27.2
Other^†	31.0	25.7-36.9	24.1	19.7-29.0
P value	<.0001		<.0001
Married
Yes	44.3	43.0-45.7	39.3	38.1-40.6
No	37.7	35.9-39.5	31.7	30.7-32.7
P value	<.0001		<.0001
Education
< High school	30.9	28.2-33.8	25.0	23.1-26.9
High school	39.5	37.7-41.4	34.2	33.0-35.4
Some college	44.3	41.9-46.8	38.2	36.6-39.7
College grad	49.0	47.2-50.9	42.1	40.2-44.1
P value	<.0001		<.0001
Insurance
Not insured	19.9	15.1-25.8	17.9	13.2-23.9
Underinsured	29.3	25.0-34.0	24.3	20.7-28.2
Fully insured	43.7	42.5-44.8	36.0	35.2-36.8
P value	<.0001		<.0001
Personal health care provider
Has 1 or more	44.4	43.3-45.5	36.3	35.5-37.1
None	18.8	16.1-21.9	11.4	9.3-14.0
P value	<.0001		<.0001
Health status
Fair/poor health	44.3	42.1-46.5	33.2	31.7-34.8
Ex/v good health	41.9	40.7-43.2	36.0	35.1-37.0
P value	.066		.002
Health access^‡
“Low”	14.8	9.1-23.1	9.1	5.9-13.7
“Medium”	24.7	22.2-27.4	19.3	17.1-21.8
“High”	45.1	43.9-46.3	37.0	36.2-37.9
P value	<.0001		<.0001
Routine checkup^§
Yes	44.8	43.6-45.9	36.8	35.9-37.6
No	20.5	17.6-23.7	15.4	12.9-18.4
P value	<.0001		<.0001
CI, confidence interval. To be up to date, men required colon cancer screening (fecal occult blood test in past year or endoscopy within 10 years), a flu shot in the past year, and a pneumonia vaccination ever. Women required those same services plus a mammogram within 2 years and Pap test within 3 years (unless prior hysterectomy). ^†Other race includes American Indian, Asian, Pacific Islander, and individuals of other or multiple race categories. ^‡Determined from 3 measures: having health insurance, having a personal health care provider, and not* reporting a cost barrier. Levels 0 and 1 were combined. Resulting levels were low, medium, and high. ^§Respondents who indicated they had a routine “checkup” in the past 2 years.

References

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