Trends in socioeconomic disparities in preventive care across the lifespan

Background: Preventive health care is critical to preventing, reducing the impact of, and avoiding deaths from many chronic and infectious diseases, an estimated 40% of all deaths in the US are preventable. Furthermore, significant disparities exist for many racial, ethnic and income groups, and these differences can vary greatly across the lifespan. By bundling the preventative care quality measures from the most recent (2011) National Healthcare Quality and Disparities Reports (NHQR-NHDR), aspects of preventive medical care needing the most attention can be determined.

Methods: 17 preventive care quality measures were extracted from the 2011 NHQR-NHDR database, and organized into 4 age groups covering the entire lifespan (children [ages 17 and below], young adults [ages 18-44], middle-age adults [ages 45-64], and the elderly [ages 65 and older]). Four methods were used to assess disparities between the racial, ethnic, or income groups (e.g. non-Hispanic Blacks, Hispanics of all races, poor/lowest income group) and the reference group (White non-Hispanics, or highest income group). These four methods include (1) two-part significance testing for most recent year, (2) trending over time, (3) gap analysis, and (4) time (in years) for groups to reach achievable benchmark.

Preliminary Findings:

Children: The gap between Hispanic children and non-Hispanic White children ages 2 to 17 with a dental visit in the last 12 months closed by 53% from 2002 to 2008.

Young Adults: Poor young adults with obesity who ever received advice from a health care provider to exercise more improved from 40.4% in 2002 to 46.6% in 2008, but was still lower than young adults with obesity from the high income group (55.2%).

Middle-aged Adults: From 2000-2008, there has been minimal improvement in mammography screening for women ages 50-64, and the number of years to reach the 2008 achievable benchmark (88%) extends beyond 25 years for all groups.

Elderly Adults: In 2008, (among women aged 65 and older) only 46.7% of non-Hispanic Black women and 62.9% of Hispanic women received osteoporosis screening which are both significantly lower than the 75% of non-Hispanic White women.

Conclusions: At each stage in the lifespan, severe disparities in preventive medical care are experienced by Blacks, Hispanics and people from the lower socioeconomic strata. Focused policies and research that can identify specific ways to improve the areas of concern highlighted from this assessment should greatly improve the lives and health of disadvantaged groups in the United States.