Creating strategies to reduce ethnic and racial disparities in the delivery of clinical preventive services to older Americans

Background: A Healthy People 2020 objective seeks to increase the proportion of older adults “up-to-date” (UTD) with recommended preventive services (CPS) based on age and gender. Objectives: To determine the optimum strategy for increasing UTD levels, while reducing disparities in UTD levels between white, black, and Hispanic adults, aged >65. Methods: Data were analyzed from the 2008 Behavioral Risk Factor Surveillance System (121,365 respondents aged >65). A measure was calculated quantifying the percentage UTD with past influenza vaccination (12 months), pneumococcal vaccination (ever), mammogram (2 years), Pap test (3 years), and colonoscopy/sigmoidoscopy (10 years or fecal occult blood test, 12 months). A comparison of projected changes in UTD levels was ascertained by numerically bringing UTD adults who lacked only one CPS (or two, for immunizations). Separate analyses were performed by gender and race/ethnicity. Results: Disparities were present for all component services in the UTD measure, except Pap tests and mammograms. Expanded provision of vaccinations and colorectal cancer screenings each led to increases in UTD levels for all groups. When those needing only vaccinations to be UTD are vaccinated, there is a projected decrease in absolute differences between white and black, and white and Hispanic UTD levels for both genders (range 12.2% - 2.3%). However, when those needing only colorectal cancer screening are screened, there is a projected increase in absolute differences between white and black, and white and Hispanic UTD levels (range 1.55% - 4.5%). Conclusions: Focusing on immunizations offers a promising strategy to reduce disparities while improving UTD levels.