title: Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study.
abstract: 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.
authors.affiliation: 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
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Chris
authors.initials: C
authors.lastname: Tonner
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Pantelis
authors.initials: P
authors.lastname: Panopalis
authors.forename: Joann Z
authors.initials: JZ
authors.lastname: Gillis
authors.forename: Aimee O
authors.initials: AO
authors.lastname: Hersh
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Julian
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Criswell
authors.forename: Edward H
authors.initials: EH
authors.lastname: Yelin
mesh_terms: 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*
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