Developing an integrated strategy to reduce ethnic and racial disparities in the delivery of clinical preventive services for older Americans

Abstract

Objectives: To determine the optimum strategy for increasing up-to-date (UTD) levels in older Americans, while reducing disparities between White, Black, and Hispanic adults, aged 65 years and older.

Methods: Data were analyzed from the 2008 Behavioral Risk Factor Surveillance System, quantifying the proportion of older Americans UTD with influenza and pneumococcal vaccinations, mammograms, Papanicolaou tests, and colorectal cancer screening. A comparison of projected changes in UTD levels and disparities was ascertained by numerically accounting for UTD adults lacking 1 or more clinical preventive services (CPS). Analyses were performed by gender and race/ethnicity.

Results: Expanded provision of specific vaccinations and screenings each increased UTD levels. When those needing only vaccinations were immunized, there was a projected decrease in racial/ethnic disparities in UTD levels (2.3%-12.2%). When those needing only colorectal cancer screening, mammography, or Papanicolaou test were screened, there was an increase in UTD disparities (1.6%-4.5%).

Conclusions: A primary care and public health focus on adult immunizations, in addition to other CPS, offers an effective strategy to reduce disparities while improving UTD levels.

FIGURE 1—

Percentage of (a) men and (b) women aged 65 years and older up-to-date by selected racial/ethnic groups in 2002, 2004, 2006, and 2008 using the Behavioral Risk Factor Surveillance System (BRFSS): United States, Reduce Ethnic and Racial Disparities in the Delivery of Clinical Preventive Services. Note. BRFSS surveys are cross-sectional, with different respondents each year.

FIGURE 2—

Current up-to-date levels (%) for (a) men and (b) women aged 65 years and older compared with levels if persons who needed 1 service or both vaccinations received the service(s), in 2008 using the Behavioral Risk Factor Surveillance System: United States, Reduce Ethnic and Racial Disparities in the Delivery of Clinical Preventive Services. Note. CRC = colorectal cancer; PPV = pneumococcal vaccination; UTD = up-to-date.

FIGURE 3—

Current absolute up-to-date disparity (%) with Whites compared with disparity (%) if (a) men and (b) women aged 65 years and older who needed 1 service or both vaccinations received the service(s), in 2008 using the Behavioral Risk Factor Surveillance System (BRFSS): United States, Reduce Ethnic and Racial Disparities in the Delivery of Clinical Preventive Services. Note. CRC = colorectal cancer; PPV = pneumococcal vaccination; UTD = up-to-date.