Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study.
BACKGROUND
Cancer and infections are leading causes of mortality in systemic lupus erythematosus (SLE) after diseases of the circulatory system, and therefore preventing these complications is important. In this study, we examined two categories of preventive services in SLE: cancer surveillance (cervical, breast, and colon) and immunizations (influenza and pneumococcal). We compared the receipt of these services in SLE to the general population, and identified subgroups of patients who were less likely to receive these services.


METHODS
We compared preventive services reported by insured women with SLE enrolled in the University of California, San Francisco Lupus Outcomes Study (n=685) to two representative samples derived from a statewide health interview survey, a general population sample (n=18,013) and a sample with non-rheumatic chronic conditions (n=4,515). In addition, using data from the cohort in both men and women (n=742), we applied multivariate regression analyses to determine whether characteristics of individuals (for example, sociodemographic and disease factors), health systems (for example, number of visits, involvement of generalists or rheumatologists in care, type of health insurance) or neighborhoods (neighborhood poverty) influenced the receipt of services.


RESULTS
The receipt of preventive care in SLE was similar to both comparison samples. For cancer surveillance, 70% of eligible respondents reported receipt of cervical cancer screening and mammography, and 62% reported colon cancer screening. For immunizations, 59% of eligible respondents reported influenza immunization, and 60% reported pneumococcal immunization. In multivariate regression analyses, several factors were associated with a lower likelihood of receiving preventive services, including younger age and lower educational attainment. We did not observe any effects by neighborhood poverty. A higher number of physician visits and involvement of generalist providers in care was associated with a higher likelihood of receiving most services.


CONCLUSIONS
Although receipt of cancer screening procedures and immunizations in our cohort was comparable to the general population, we observed significant variability by sociodemographic factors such as age and educational attainment. Further research is needed to identify the physician, patient or health system factors contributing to this observed variation in order to develop effective quality improvement interventions.
Yazdany
Jinoos
J
Division of Rheumatology, University of California, San Francisco, and General Clinical Research Center, Moffit Hospital, UCSF Box 0920, San Francisco, CA 94143-0920, USA. jinoos.yazdany@ucsf.edu
Tonner
Chris
C
Trupin
Laura
L
Panopalis
Pantelis
P
Gillis
Joann Z
JZ
Hersh
Aimee O
AO
Julian
Laura J
LJ
Katz
Patricia P
PP
Criswell
Lindsey A
LA
Yelin
Edward H
EH
D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000517:prevention & control; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D017589:Immunization Programs; D007251:Influenza, Human / Q000517:prevention & control*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D015999:Multivariate Analysis; D011018:Pneumonia, Pneumococcal / Q000517:prevention & control; D011159:Population Surveillance; D011314:Preventive Health Services; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
Arthritis Rheum. 2008 Jan 15;59(1):136-43
18163398
Vaccine. 2007 Jun 15;25(25):4775-83
17499402
Arthritis Rheum. 2007 May 15;57(4):593-600
17471526
Am J Manag Care. 2003 Apr;9(4):293-301
12703673
Arthritis Rheum. 2006 Aug;54(8):2550-7
16868977
JAMA. 2001 Sep 26;286(12):1455-60
11572737
Lupus. 2009 Jul;18(8):682-9
19502263
Arthritis Rheum. 2007 Feb 15;57(1):56-63
17266065
MMWR Recomm Rep. 1997 Apr 4;46(RR-8):1-24
9132580
Ann Intern Med. 2009 Apr 7;150(7):465-73
19349631
Med Care. 2007 Oct;45(10):931-8
17890990
Cancer Epidemiol Biomarkers Prev. 2008 Apr;17(4):748-57
18381468
Ann Fam Med. 2003 Jul-Aug;1(2):90-6
15040438
Inflamm Bowel Dis. 2008 Feb;14(2):253-8
17932966
Arthritis Rheum. 2009 Mar 15;61(3):370-7
19248127
J Rheumatol. 2003 Sep;30(9):1940-7
12966594
Lupus. 2006;15(11):778-83
17153850
Arch Intern Med. 2007 Mar 26;167(6):580-5
17389289
J Urban Health. 2006 Mar;83(2):195-210
16736369
MMWR Recomm Rep. 2004 May 28;53(RR-6):1-40
15163927
J Rheumatol. 2008 Oct;35(10):1906-8
18843755
Epidemiol Infect. 2007 Jan;135(1):139-43
16740194
Diabetes Care. 2001 Dec;24(12):2049-53
11723081
Vaccine. 2009 Nov 5;27(47):6546-9
19729083
N Engl J Med. 1948 Oct 14;239(16):565-70
18886963
Arthritis Rheum. 1982 Nov;25(11):1271-7
7138600
Am J Public Health. 2003 Apr;93(4):635-41
12660210
Ann Rheum Dis. 2001 Dec;60(12):1141-4
11709457
Ann Rheum Dis. 2007 Jun;66(6):837-8
17513572
J Rheumatol. 2006 Jan;33(1):45-9
16331804
Health Aff (Millwood). 2002 Jul-Aug;21(4):63-86
12117154
J Rheumatol. 2008 Sep;35(9):1782-8
18634153
Arthritis Rheum. 2007 May 15;57(4):601-7
17471527
Lupus. 2003;12(4):280-6
12729051