Trends in Differences Across Subgroups of Adults in Preventive Services Utilization

Med Care. 2021 Dec 1;59(12):1059-1066. doi: 10.1097/MLR.0000000000001634.


Background: There were large differences across subgroups of adults in preventive services utilization before 2010. The Affordable Care Act had numerous provisions aimed at increasing utilization as well as at reducing disparities.

Objective: This study examines whether preventive services utilization changed over time, across subgroups of adults defined by race/ethnicity, insurance coverage, poverty status, Census region, and urbanicity.

Methods: Data from the Medical Expenditure Panel Survey Household Component are used to examine service utilization before the passage of the Affordable Care Act (2008/2009), after the implementation of the preventive services mandate and the dependent coverage provision (2012/2013), and after Medicaid expansions (2015/2016). Four preventive services are examined for adults aged 19-64-general checkups, blood cholesterol screening, mammograms, and colorectal cancer screening. Multivariate logistic regression models are used to predict preventive services utilization of adult subgroups in each time period, and to examine how differences across subgroups changed between 2008/2009 and 2015/2016.

Results: There were modest increases in utilization between 2008/2009 and 2015/2016 for blood cholesterol and colorectal cancer screenings. For 3 of 4 preventive services, differences between the Northeast and the Midwest regions narrowed. However, large gaps in utilization across income groups and between those with and without coverage persisted. Disparities across racial/ethnic groups in general checkups persisted over time as well.

Conclusion: While some differences have narrowed, large gaps in preventive service utilization across population subgroups remain.

MeSH terms

  • Adult
  • Female
  • Humans
  • Income / statistics & numerical data
  • Insurance Coverage / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Preventive Medicine / methods
  • Preventive Medicine / trends*
  • Racial Groups / ethnology
  • Racial Groups / statistics & numerical data