title: Obesity and receipt of clinical preventive services in veterans.
abstract: Although obese individuals utilize health care at higher rates than their normal weight counterparts, they may be less likely to receive certain preventive services. We conducted a retrospective cohort study of veterans with visits to 136 national Veterans Affairs (VA) outpatient clinics in the United States in the year 2000. The cohort included 1,699,219 patients: 94% men, 48% white, and 76% overweight or obese. Overweight and obese patients had higher adjusted odds of receiving each of the targeted clinical preventive services as recommended over 5 years compared with normal weight patients. The odds for receiving vaccinations increased linearly with BMI category: influenza (men: odds ratio (OR) = 1.13 for overweight to OR = 1.42 for obese class 3; women: OR = 1.15 for overweight to OR = 1.61 for obese class 3) and pneumococcus (men: OR = 1.02 for overweight to OR = 1.15 for obese class 3; women: OR = 1.08 for overweight to OR = 1.28 for obese class 3). The odds for receiving the cancer screening services typically peaked in the mild-moderately obese categories. The highest OR for prostate cancer screening was in obese class 2 (OR = 1.29); for colorectal cancer, obese class 1 (men: OR = 1.15; women OR = 1.10); for breast cancer screening, obese class 2 (OR = 1.19); and for cervical cancer screening, obese class 2 (OR = 1.06). In a large national sample, obese patients received preventive services at higher, not lower, rates than their normal weight peers. This may be due to the VA health service coverage and performance directives, a more homogeneous patient demographic profile, and/or unmeasured factors related to service receipt.
authors.affiliation: Department of Veterans Affairs Medical Center, Center for Health Services Research in Primary Care, Durham, North Carolina, USA. yancy006@mc.duke.edu
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: McDuffie
authors.forename: Karen M
authors.initials: KM
authors.lastname: Stechuchak
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kinsinger
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Krause
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D015992:Body Mass Index; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007251:Influenza, Human / Q000150:complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy; D016017:Odds Ratio; D011008:Pneumococcal Infections / Q000150:complications / Q000517:prevention & control; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D059039:Standard of Care; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans