240443 Creating strategies to reduce ethnic and racial disparities in the delivery of clinical preventive services to older Americans

Monday, October 31, 2011

Douglas Shenson, MD MPH MS , Sickness Prevention Achieved through Regional Collaboration (SPARC), Newton, MA
Mary Adams, MPH , On Target Health Data LLC, West Suffield, CT
Julie Bolen, PhD , Health Care and Aging Studies Branch, CDC, Atlanta, GA
Karen Wooten, MA , National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA
Juliana Clough , Rolllins School of Public Health, Emory University, Winchester, MA
Lynda Anderson, PhD , National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Describe the Healthy People 2020 objective to increase the proportion of older adults “up-to-date” (UTD) with recommended clinical preventive services based on age and gender. 2. Differentiate the component clinical preventive services in the Healthy People 2020 objective to increase the proportion of older adults UTD with these recommended clinical preventive services. 3. Explain how strategies for increasing the delivery of the component services in this measure will affect the level of racial and ethnic disparities in older Americans being UTD with these services.

Keywords: Disease Prevention, Elderly

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee disease prevention programs and teach epidemiology & public health (at Yale School of Medicine).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.