Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States

Article Figures & Data

Table 1.

Characteristics of a National Sample of Elderly, Community-Dwelling, non-HMO, Medicare Beneficiaries*

Characteristics	Minority (n = 2187)	White (n = 13,775)	P Value (for χ² or t test)
Age			<.0001
65 to 69	25.0	20.2
70 to 74	21.7	21.8
75 to 79	19.7	21.7
80 to 84	15.6	20.3
85+	18.1	15.9
Sex			<.0001
Male	38.4	43.4
Female	61.6	56.7
Education			<.0001
Less than high school graduate	61.9	28.8
At least high school graduate	38.1	71.2
Metropolitan area			<.0001
No	23.5	32.9
Yes	76.5	67.1
Income			<.0001
≤25,000 annual	85.4	57.6
>25,000 annual	14.6	42.4
Lives alone			<.1585
No	67.1	65.6
Yes	32.9	34.4
Proxy responded			<.0001
No	84.6	92.2
Yes	15.4	7.9
Supplemental insurance			<.0001
None	23.1	12.8
Medicaid	35.5	6.1
Private insurance	41.4	81.1
Number of primary care office visits			<.0001
None	36.7	28.9
1 to 2	20.5	26.8
3 or more	42.8	44.3
Activities of Daily Living^†	1.8	1.6	<.0001
Self-assessed health status^‡	3.1	2.7	<.0001

* Data derived from Medicare Current Beneficiary Survey (Access to Care), 1998 to 2002.
† On a 3-point scale, with higher scores indicating more impairment.
‡ On a 5-point scale, with higher scores indicating poorer health.

Table 2.

Effects of Minority Status on Receipt of Preventive Care Services

Covariates Included in Models	Odds Ratios for Claim for a Preventive Care Service by Minority Status
Covariates Included in Models	Colon Cancer Screening	Influenza Vaccination	Lipid Screening	Mammogram	Pap Smear
Age	0.59 (0.51–0.69)	0.50 (0.44–0.56)	0.81 (0.72–0.91)	0.59 (0.51–0.68)	0.61 (0.5–0.75)
Age, frequency of primary care visits	0.63 (0.53–0.72)	0.51 (0.45–0.57)	0.86 (0.76–0.97)	0.61 (0.53–0.7)	0.64 (0.52–0.79)
Age, frequency of primary care visits, education level	0.69 (0.59–0.81)	0.54 (0.47–0.6)	0.92 (0.81–1.04)	0.71 (0.61–0.81)	0.76 (0.62–0.94)
All covariates (listed in Table 1)	0.79 (0.67–0.94)	0.56 (0.49–0.64)	0.95 (0.84–1.08)	0.9 (0.77–1.05)	0.94 (0.76–1.17)

Table 3.

Factors Associated with Receipt of Colorectal Screening

Patient Characteristic	OddsRatio	Lower 95%ConfidenceInterval	Upper 95%ConfidenceInterval
Race or ethnicity (referent: non-Hispanic white)
Minority	0.79	0.67	0.94
Age (referent: ≥85 years)
65 to 69	1.29	1.13	1.48
70 to 74	1.33	1.17	1.52
75 to 79	1.44	1.27	1.62
80 to 84	1.18	1.03	1.35
Educational attainment
Less than high school	0.84	0.76	0.93
Residence (referent: nonmetropolitan residence)
Metropolitan area	1.12	1.00	1.25
Income (referent: <$25,000)
≤$25,000	0.80	0.73	0.88
Functional health (3-point scale)
1 point decrease	0.89	0.85	0.94
Self-rated health (5-point scale)
1 point decrease	0.99	0.95	1.04
Living situation (referent: married or cohabitating)
Lives alone	1.06	0.96	1.16
Respondent (referent: participant)
Proxy	0.79	0.66	0.95
Supplemental insurance (referent: private)
None	0.58	0.50	0.68
Medicaid	0.77	0.65	0.92
Survey year (referent: 4)
1	0.76	0.69	0.85
2	1.15	1.01	1.31
3	1.02	0.87	1.18
Number of primary care office visits (referent: none)
1 to 2	2.31	1.99	2.68
3 or more	3.33	2.85	3.90
Sex (referent: male)
Female	1.07	0.98	1.17

Table 4.

Factors Associated with Receipt of Influenza Vaccination

Patient Characteristic	OddsRatio	Lower 95%ConfidenceInterval	Upper 95%ConfidenceInterval
Race or ethnicity (referent: non-Hispanic white)
Minority	0.56	0.49	0.64
Age (referent: ≥85 years)
65 to 69	0.69	0.58	0.82
70 to 74	0.93	0.82	1.07
75 to 79	1.07	0.94	1.21
80 to 84	1.11	0.97	1.26
Educational attainment (referent: at least high school)
Less than high school	0.93	0.85	1.02
Residence (referent: nonmetropolitan residence)
Metropolitan area	0.88	0.76	1.02
Income (referent: >$25,000)
≤$25,000	0.81	0.73	0.90
Functional health (3-point scale)
1 point decrease	0.96	0.91	1.02
Self-rated health (5-point scale)
1 point decrease	1.00	0.96	1.05
Living situation (referent: married or cohabitating)
Lives alone	1.11	1.02	1.21
Respondent (referent: participant)
Proxy	0.90	0.76	1.07
Supplemental insurance (referent: private)
None	0.58	0.51	0.67
Medicaid	0.78	0.65	0.94
Survey year (referent: 4)
1	0.13	0.11	0.15
2	1.04	0.93	1.17
3	1.09	0.97	1.22
Number of primary care office visits (referent: none)
1 to 2	1.92	1.68	2.19
3 or more	2.96	2.61	3.35
Sex (referent: male)
Female	1.05	0.95	1.15

Table 5.

Factors Associated with Receipt of Lipid Screening

Patient Characteristic	OddsRatio	Lower 95% Confidence Interval	Upper 95% ConfidenceInterval
Race or ethnicity (referent: non-Hispanic white)
Minority	0.95	0.84	1.08
Age (referent: ≥85 years)
65 to 69	1.71	1.51	1.95
70 to 74	1.87	1.65	2.12
75 to 79	1.68	1.50	1.89
80 to 84	1.42	1.26	1.60
Educational attainment (referent: at least high school)
Less than high school	0.91	0.83	0.99
Residence (referent: nonmetropolitan residence)
Metropolitan area	1.17	1.00	1.36
Income (referent: >$25,000)
≤$25,000	0.85	0.78	0.92
Functional health (3-point scale)
1 point decrease	0.91	0.87	0.94
Self-rated health (5-point scale)
1 point decrease	1.06	1.02	1.10
Living situation (referent: married or cohabitating)
Lives alone	1.15	1.06	1.25
Respondent (referent: participant)
Proxy	0.64	0.56	0.73
Supplemental insurance (referent: private)
None	0.67	0.61	0.74
Medicaid	1.06	0.93	1.21
Survey year (referent: 4)
1	0.79	0.71	0.88
2	1.05	0.93	1.18
3	1.06	0.94	1.19
Number of primary care office visits (referent: none)
1 to 2	2.56	2.29	2.85
At least 3	4.29	3.84	4.79
Sex (referent: male)
Female	1.04	0.96	1.13

Table 6.

Factors Associated with Receipt of Mammography Screening

Patient Characteristic	OddsRatio	Lower 95% ConfidenceInterval	Upper 95% ConfidenceInterval
Race or ethnicity (referent: non-Hispanic white)
Minority	0.90	0.77	1.05
Age (referent: ≥85 years)
65 to 69	3.40	2.74	4.21
70 to 74	3.06	2.53	3.71
75 to 79	2.68	2.20	3.26
80 to 84	2.27	1.86	2.79
Educational attainment (referent: at least high school)
Less than high school	0.78	0.70	0.88
Residence (referent: nonmetropolitan residence)
Metropolitan area	0.96	0.80	1.15
Income (referent: >$25,000)
≤$25,000	0.74	0.65	0.84
Functional health (3-point scale)
1 point decrease	0.86	0.82	0.91
Self-rated health(5-point scale)
1 point decrease	0.92	0.88	0.97
Living situation (referent: married or cohabitating)
Lives alone	0.99	0.89	1.10
Respondent (referent: participant)
Proxy	0.55	0.42	0.71
Supplemental insurance (referent: private)
None	0.51	0.41	0.62
Medicaid	0.75	0.62	0.90
Survey year (referent: 4)
1	0.52	0.45	0.60
2	0.89	0.76	1.05
3	0.96	0.81	1.16
Number of primary care office visits (referent: none)
1 to 2	2.41	1.99	2.91
At least 3	2.95	2.46	3.54

Table 7.

Factors Associated with Receipt of Papanicolaou Screening

Patient Characteristic	OddsRatio	Lower 95% Confidence Interval	Upper 95% ConfidenceInterval
Race or ethnicity (referent: non-Hispanic white)
Minority	0.94	0.76	1.17
Age (referent: ≥85 years)
65 to 69	4.39	3.43	5.61
70 to 74	4.00	3.14	5.08
75 to 79	2.90	2.23	3.77
80 to 84	2.03	1.59	2.59
Educational attainment (referent: at least high school)
Less than high school	0.76	0.66	0.88
Residence (referent: nonmetropolitan residence)
Metropolitan area	1.14	0.96	1.35
Income (referent: >$25,000)
≤$25,000	0.75	0.65	0.88
Functional health (3-point scale)
1 point decrease	0.90	0.84	0.97
Self-rated health (5-point scale)
1 point decrease	0.85	0.79	0.91
Living situation (referent: married or cohabitating)
Lives alone	1.19	1.02	1.38
Respondent (referent: participant)
Proxy	0.83	0.57	1.20
Supplemental insurance (referent: private)
None	0.78	0.62	0.98
Medicaid	0.69	0.53	0.89
Survey year (referent: 4)
1	0.84	0.72	0.99
2	1.01	0.85	1.21
3	1.06	0.88	1.29
Number of primary care office visits (referent: none)
1 to 2	4.55	3.53	5.87
At least 3	6.90	5.33	8.93