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Researchers examine disparities in receipt of preventive care

The incidence of diabetes is increasing among adults 30 to 59 years of age in the United States. Compared with older people who have diabetes, these younger diabetes patients are substantially less likely to receive important preventive care services such as eye and foot exams, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality. A second AHRQ-supported study found that morbidly obese women, who are more likely than others to develop colorectal cancer and die from it, are less likely to be screened for it. Both studies are summarized here.

Persell, S.D., Zaslavsky, A.M., Weissman, J.S., and Ayanian, A.M. (2004, May). "Age-related differences in preventive care among adults with diabetes." (T32 HS00020). American Journal of Medicine 116, pp. 630-634.

This survey of individuals with diabetes, including those with longstanding diabetes, revealed that adults aged 18 to 44 received significantly less diabetes-related preventive care than those aged 65 and older. Young adults have a greater lifetime risk of developing complications of diabetes such as eye and kidney disease and circulatory problems that can lead to amputation. In addition, many of the age-related disparities in diabetes-related preventive services may be large enough to affect clinical outcomes, according to the investigators. They analyzed data on preventive care received by 6,565 adults with diabetes who responded to a 1999 Behavioral Risk Factor Surveillance System survey.

Overall, 85 percent of young adults had seen a health care provider for diabetes in the past year. Yet, except for professional foot examinations (to detect nonhealing wounds that can lead to infection, gangrene, and amputation) and testing of blood sugar levels, young (aged 18 to 44 years) and middle-aged (45-64 years) patients received fewer preventive services than older patients. For example, 84 percent of those aged 65 and older—versus 82 percent of middle-aged and 69 percent of young patients—had their cholesterol checked in the past 2 years; corresponding figures for dilated eye exam were 75 percent, 66 percent, and 55 percent; pneumococcal vaccination ever, 54 percent, 28 percent, and 17 percent; and influenza vaccination in the past year, 73 percent, 46 percent, and 34 percent.

Rosen, A.B., and Schneider, E.C. (2004, April). "Colorectal cancer screening disparities related to obesity and gender." (AHRQ grant T32 HS00020). Journal of General Internal Medicine 19, pp. 332-338.

Colorectal cancer is the second leading cause of cancer death in the United States. Colorectal cancer screening is the key to early diagnosis and treatment, yet screening rates among age-eligible people in the United States are disturbingly low. Furthermore, morbidly obese women are less likely than others to be screened for colorectal cancer, according to this study. The investigators examined self-reported colorectal cancer screening with fecal occult blood testing (FOBT) within the past year or endoscopic screening (sigmoidoscopy or colonoscopy) within the past 5 years among 52,886 people aged 51 to 80 who responded to the Behavioral Risk Factor Surveillance System survey of noninstitutionalized adults. The survey was conducted by the Centers for Disease Control and Prevention and State health departments in 1999.

The overall colorectal cancer screening rate was 43.8 percent. The rate of screening by FOBT within the previous year or endoscopic screening within the past 5 years was 39.5 percent for the morbidly obese group, 45 percent for the obese group, 44.3 percent for the overweight group, and 43.5 percent for the normal weight group. After adjustment for other potential confounding factors, morbidly obese women were nearly 6 percent less likely to be screened than normal weight women.

Screening rates among normal weight, overweight, and obese women, and among men in different weight groups did not differ significantly. Efforts should be made to increase colorectal cancer screening for all age-eligible groups. These efforts should include targeted screening of morbidly obese women, since they could reap substantial clinical benefits from screening. The observed sex and weight interaction is consistent with prior research suggesting that bias and stigmatization related to obesity may be more severe for women than men.

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