title: Preventive care utilization among the uninsured by race/ethnicity and income.
abstract: BACKGROUND
  Health insurance status affects access to preventive services. Effective use of preventive services is a key factor in the reduction of important health concerns and has the potential to enable adults to live longer, healthier lives.
  
  
  OBJECTIVE
  To analyze the use of U.S. Preventive Services Task Force (USPSTF)-recommended preventive services among uninsured adults, with a focus on variation across race, ethnicity, and household income.
  
  
  METHODS
  Using pooled 2004-2011 Medical Expenditure Panel Survey data, this study conducted multivariate logistic regressions to estimate variation in receipt of eight USPSTF-recommended preventive services by race/ethnicity among adults aged 18 years and older uninsured in the previous year. Stratified analyses by household income were applied. Data were analyzed in 2013.
  
  
  RESULTS
  Uninsured adults received preventive services far below Healthy People 2020 targets. Among the uninsured, African Americans had higher odds of receiving Pap tests, mammograms, routine physical checkups, and blood pressure checks according to guidelines than whites. Moreover, compared to whites, Hispanics had higher odds of receiving Pap tests, mammograms, influenza vaccinations, and routine physical checkups and lower odds of receiving blood pressure screening and advice to quit smoking. When results were stratified by household income, racial/ethnic differences persisted except for the highest income levels (≥400% Federal Poverty Level), where they were largely non-significant.
  
  
  CONCLUSIONS
  Generally, uninsured African American and Hispanic populations fare better than uninsured whites in preventive service utilization. Future research should examine reasons behind these racial/ethnic differences to inform policy interventions aiming to increase preventive service utilization among the uninsured.
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland. Electronic address: cdholden@umd.edu.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Holden
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland.
authors.forename: Rada K
authors.initials: RK
authors.lastname: Dagher
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D019983:Guideline Adherence; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology* / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D011203:Poverty / Q000208:ethnology / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult