Are older women receiving routine clinical preventive services? A composite measure highlights racial and geographic disparities

Background: We used a composite measure to examine the delivery of routine clinical preventive services to U.S. women aged 50-64 years and >=65 years in 2004. Methods: We analyzed state data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS) and created a composite measure that included screening of women >=50 years for colorectal cancer, cervical cancer, breast cancer, vaccination against influenza, and for women aged >=65 years only, pneumococcal vaccination. The composite measure quantified the percentage of women who were up-to-date (UTD) according to recommended schedules for these services. Results: Approximately 23% of women aged 50-64 years and 32.5% of women aged >=65 years were UTD in 2004. Results varied by education, race/ethnicity, marriage status, insurance status, and health status. The percent UTD was similar for White women and Black women aged 50-64 years, but among women aged >=65 years Black women were significantly less likely to be UTD. Hispanic women aged 50-64 were less likely to be UTD than White women. There was also considerable geographic variation in state-specific UTD estimates, ranging from 16.7% (CA) to 38.4% (MN) for women aged 50-64 years and from 25.7% (IN) to 48.5% (MN) for women aged >=65 years. Conclusion: Although rates for some individual services were at or over 75%, the percentage of women aged 50-64 years and >=65 years UTD on all routinely recommended cancer screenings and vaccinations was low, with less than 1 in 3 being UTD.