Developing an integrated strategy to reduce ethnic and racial disparities in the delivery of clinical preventive services for older Americans.
OBJECTIVE
To determine the optimum strategy for increasing up-to-date (UTD) levels in older Americans, while reducing disparities between White, Black, and Hispanic adults, aged 65 years and older.


METHODS
Data were analyzed from the 2008 Behavioral Risk Factor Surveillance System, quantifying the proportion of older Americans UTD with influenza and pneumococcal vaccinations, mammograms, Papanicolaou tests, and colorectal cancer screening. A comparison of projected changes in UTD levels and disparities was ascertained by numerically accounting for UTD adults lacking 1 or more clinical preventive services (CPS). Analyses were performed by gender and race/ethnicity.


RESULTS
Expanded provision of specific vaccinations and screenings each increased UTD levels. When those needing only vaccinations were immunized, there was a projected decrease in racial/ethnic disparities in UTD levels (2.3%-12.2%). When those needing only colorectal cancer screening, mammography, or Papanicolaou test were screened, there was an increase in UTD disparities (1.6%-4.5%).


CONCLUSIONS
A primary care and public health focus on adult immunizations, in addition to other CPS, offers an effective strategy to reduce disparities while improving UTD levels.
Sickness Prevention Achieved through Regional Collaboration (SPARC), Newton, MA 02465, USA. dshenson@sparc-health.org
Douglas
D
Shenson
Mary
M
Adams
Julie
J
Bolen
Karen
K
Wooten
Juliana
J
Clough
Wayne H
WH
Giles
Lynda
L
Anderson
D001741:Black or African American; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D003113:Colonoscopy / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D065006:Papanicolaou Test; D011314:Preventive Health Services / Q000592:standards* / Q000706:statistics & numerical data; D014611:Vaccination / Q000706:statistics & numerical data; D014626:Vaginal Smears / Q000706:statistics & numerical data; D044465:White People