 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Joseph J. Sudano, PhD, School of Medicine, Case Western Reserve University, MetroHealth Medical Center, Rammelkamp 236, 2500 MetroHealth Drive, Cleveland, OH 44109, 216-778-1399, jsudano@metrohealth.org and David W. Baker, MD, MPH, The Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Room 255, Chicago, IL 60611.
Objective: To determine factors that help explain racial/ethnic differences in preventive service usage.
Design: We used data from the 1992, 1994, and 1996 Health and Retirement Study (HRS), a nationally representative sample of adults age 51-61 in 1992. Outcome measures included 1996 questions about preventive services use in the past two years, including: influenza vaccination; cholesterol test; mammography, Pap test, breast self-examination (BSE); prostate examination. Logistic regression models were constructed to examine the degree to which sets of factors (health status, SES, insurance, health behaviors) help explain racial/ethnic differences in preventive services use.
Population: 5605 non-Hispanic whites (W), 1110 non-Hispanic blacks (B), 332 English-speaking Hispanics (E/H), and 253 Spanish-speaking Hispanics (S/H).
Findings: No significant differences in any services use were found between W and E/H. After controlling for SES and insurance, B and S/H likelihood of obtaining influenza vaccination increased, but the disparities were not totally eliminated. Lower SES and lack of insurance coverage completely explained the lower rates of prostate exams for B and S/H men compared to W. For B women, no significant disparities in preventive services use were found as compared to W. To the contrary, when SES and insurance coverage were added to the models, B women were more likely to have had a Pap test or mammogram as compared to W (12 and 14 percent, respectively). B women were 20 percent more likely to engage in BSE as compared to W. For S/H women, differences in unadjusted relative risks were eliminated after controls for health status. As with B women, S/H were more likely to have had a Pap test or mammogram after controlling for SES and insurance, but this likelihood was not statistically significant. Finally, S/H women were 20 percent less likely to perform BSE as compared to W, even after all control variables and covariates were included in the model.
Conclusions: SES and insurance help to explain much of the racial/ethnic disparities in preventive services use. However, lower SES or lack of insurance coverage did not explain the disparities in influenza vaccination for both B and S/H. Likewise, public health messages may have increased awareness of BSE for B but not for S/H women.
Implications for Policy, Delivery, or Practice: Public health initiatives should target minority populations with multi-lingual educational messages regarding the efficacy of preventive services. Expansion of health insurance coverage to the uninsured should also be re-examined.
Learning Objectives:
Keywords: Access and Services, Health Insurance
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.