Article Figures & Data
Tables
Characteristics No Conditions n (%) 1 Condition n (%) 2 Conditions n (%) ≥3 Conditions n (%) P Value Total 503 (15) 646 (19) 786 (23) 1498 (44) Community A 121 (24) 182 (28) 302 (38) 624 (42) <.001 B 382 (76) 464 (72) 484 (62) 874 (58) Sex Female 268 (53) 346 (54) 419 (53) 837 (56) .55 Male 235 (47) 300 (46) 367 (47) 661 (44) Age, years 50–59 291 (58) 287 (44) 303 (39) 465 (31) <.001 60–64 94 (19) 150 (23) 159 (20) 321 (21) 65–75 85 (17) 138 (21) 201 (26) 382 (26) >75 33 (7) 71 (11) 123 (16) 330 (22) Ethnicity Hispanic 42 (8) 92 (14) 109 (14) 180 (12) .02 Non-Hispanic 154 (31) 199 (31) 224 (29) 491 (33) Unspecified 307 (61) 355 (55) 453 (58) 827 (55) Race White 228 (45) 332 (51) 444 (56) 1016 (68) <.001 Other 14 (3) 21 (3) 25 (3) 40 (3) Unspecified 261 (52) 293 (45) 317 (40) 442 (30) Marital status Partnered 336 (67) 423 (65) 490 (62) 890 (59) <.001 Not partnered 99 (20) 150 (23) 223 (28) 510 (34) Unknown 68 (14) 73 (11) 73 (9) 98 (7) Occupation Employed 288 (57) 343 (53) 342 (44) 456 (30) <.001 Unemployed/disabled 21 (4) 48 (7) 75 (10) 256 (17) Retired 104 (21) 144 (22) 237 (30) 566 (38) Unknown 90 (18) 111 (17) 132 (17) 220 (15) Insurance Private 317 (63) 363 (56) 404 (51) 756 (50) <.001 Medicare/Private 33 (7) 93 (14) 136 (17) 311 (21) Medicaid/Medicare 15 (3) 19 (3) 34 (4) 122 (8) Uninsured 34 (7) 48 (7) 81 (10) 120 (8) Unknown 104 (21) 123 (19) 131 (17) 189 (13) Body mass index, kg/m2 <25 151 (30) 133 (21) 126 (16) 215 (14) <.001 25–29 138 (27) 176 (27) 211 (27) 348 (23) ≥30 65 (13) 165 (26) 237 (30) 522 (35) Unknown 149 (30) 172 (27) 212 (27) 413 (28) Smoking history Nonsmoker 350 (70) 407 (63) 451 (57) 689 (46) <.001 Former smoker 82 (16) 143 (22) 187 (24) 454 (30) Current smoker 20 (4) 50 (8) 105 (13) 305 (20) Unknown 51 (10) 46 (7) 43 (5) 50 (3) Alcohol use Nonuser 170 (34) 256 (40) 331 (42) 697 (47) <.001 Former user 20 (4) 32 (5) 58 (7) 136 (9) Current user 245 (49) 293 (45) 329 (42) 570 (38) Unknown 68 (14) 65 (10) 68 (9) 95 (6) Mean length of contact with clinic, years (SD) 10.4 (10.1) 11.7 (11.0) 12.7 (11.1) 14.3 (10.9) .13 Health care visits in past 5 years, mean (SD) 5.2 (4.9) 8.4 (7.0) 12.5 (13.7) 24.0 (24.3) <.001 Chronic diseases Arthritis/MS/joint disease 0 (0) 76 (12) 207 (26) 884 (59) <.001 No disease 503 (100) 570 (88) 579 (74) 614 (41) Asthma/COPD/chronic respiratory 0 (0) 22 (3) 58 (7) 353 (24) <.001 No disease 503 (100) 624 (97) 728 (93) 1145 (76) Cardiovascular disease 0 (0) 49 (8) 118 (15) 598 (40) <.001 No disease 503 (100) 597 (92) 668 (85) 900 (60) Chronic digestive disorders 0 (0) 67 (10) 153 (19) 596 (40) <.001 No disease 503 (100) 579 (90) 633 (81) 902 (60) Diabetes mellitus type 1 or 2 0 (0) 44 (7) 116 (15) 436 (29) <.001 No disease 503 (100) 602 (93) 670 (85) 1062 (71) Depression/anxiety 0 (0) 81 (13) 162 (21) 673 (45) <.001 No disease 503 (100) 565 (87) 624 (79) 825 (55) Hypertension 0 (0) 173 (27) 413 (53) 1068 (71) <.001 No disease 503 (100) 473 (73) 373 (47) 430 (29) Low back pain 0 (0) 58 (9) 129 (16) 626 (42) <.001 No disease 503 (100) 588 (91) 657 (84) 872 (58) Up-to-date status Colorectal cancer in men Up to date 77 (33) 103 (34) 146 (40) 271 (41) .06 Not up to date 158 (67) 197 (66) 221 (60) 390 (59) Colorectal cancer in women Up to date 96 (36) 128 (37) 132 (32) 331 (40) .05 Not up to date 172 (64) 218 (63) 287 (69) 506 (60) Breast cancer Up to date 125 (47) 176 (51) 199 (48) 420 (51) .60 Not up to date 142 (53) 170 (49) 217 (52) 410 (49) Cervical cancer Up to date 87 (53) 90 (54) 77 (50) 130 (51) .82 Not up to date 76 (47) 76 (46) 78 (50) 126 (49) COPD, chronic obstructive pulmonary disease; MS, multiple sclerosis.
- Table 2. Unadjusted and Adjusted Odds Ratios for Up-to-Date Breast Cancer Screening Status According to US Preventive Services Task Force Guidelines by Number of Chronic Conditions
Conditions (n) Up-to-Date Mammography Status All Chronic Conditions Excluding Patients with Digestive Disorders Bivariate OR (95% CI) P Value Model 1,* Adjusted OR (95% CI) P Value Model 2,† Adjusted P Value Model 3,‡ Adjusted OR (95% CI) P Value 0 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1 1.23 (0.89–1.71) .21 0.94 (0.66–1.33) .72 1.09 (0.75–1.58) .66 1.10 (0.75–1.61) .64 2 1.15 (0.84–1.57) .39 0.74 (0.52–1.04) .08 0.93 (0.64–1.35) .70 0.84 (0.56–1.27) .41 ≥3 1.30 (0.98–1.73) .07 0.62 (0.45–0.87) .005 0.83 (0.57–1.22) .35 0.68 (0.44–1.03) .07 Analyses are limited to women with no history of bilateral mastectomy or prior abnormal mammogram (n = 1859). All models included clinic as a random effect.
↵* Adjusted for total visit count in past 5 years only.
↵† Adjusted for age, marital status, ethnicity, body mass index classification, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, and total number of visits in past 5 years.
↵‡ Adjusted for age, marital status, ethnicity, body mass index classification, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, total number of visits in past 5 years; limited to women with no digestive disease (n = 1379).
- Table 3. Unadjusted and Adjusted Individual Chronic Conditions Association with Being Up to Date for Breast Cancer Screening According to US Preventive Services Task Force Guidelines
Chronic Disease Up-to-date Mammography Status Unadjusted Bivariate OR OR Adjusted for Demographics and Chronic Diseases* Final Model† OR (95% CI) P Value OR (95% CI) P Value OR (95% CI) P Value None 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) Arthritis 1.10 (0.91–1.34) .33 0.94 (0.74–1.18) .58 Dropped Respiratory disease 0.71 (0.54–0.94) .02 0.60 (0.44–0.81) .001 0.59 (0.43–0.80) .001 Cardiovascular disease 0.71 (0.56–0.91) .006 0.71 (0.54–0.94) .02 0.71 (0.54–0.94) .02 Digestive disorders 1.64 (1.32–2.04) <.001 1.33 (1.04–1.70) .02 1.31 (1.03–1.66) .03 Diabetes mellitus type 1 or 2 0.94 (0.72–1.21) .61 0.83 (0.62–1.13) .23 Dropped Depression/anxiety 1.19 (0.98–1.45) .09 0.89 (0.71–1.13) .34 Dropped Hypertension 1.06 (0.87–1.27) .58 1.11 (0.88–1.40) .38 Dropped Low-back pain 1.23 (0.98–1.53) .07 0.92 (0.71–1.19) .51 Dropped Analysis limited to women with no history of bilateral mastectomy or prior abnormal mammogram (n = 1859). All models included clinic as a random effect.
↵* Adjusted for age, marital status, ethnicity, body mass index classification, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, total number of visits in past 5 years, and the rest of the chronic diseases.
↵† Adjusted for age, marital status, body mass index classification, history of alcohol use, history of smoking, insurance status, length of contact with clinic, total number of visits in past 5 years, asthma, cardiovascular disease, and digestive disorders.
- Table 4. Unadjusted and Adjusted Odds Ratios for Up-to-Date Cervical Cancer Screening Status According to US Preventive Services Task Force Guidelines by Number of Chronic Conditions
Number of Conditions Up-to-Date for Cervical Cancer Screening All Chronic Conditions Excluding Patients with Digestive Disorders Bivariate OR (95% CI) P Value Model 1,* Adjusted OR (95% CI) P Value Model 2,† Adjusted OR (95% CI) P Value Model 3,‡ Adjusted OR (95% CI) P Value 0 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1 1.05 (0.68–1.63) .81 0.79 (0.49–1.26) .32 0.75 (0.44–1.27) .28 0.79 (0.46–1.36) .40 2 0.89 (0.57–1.40) .62 0.58 (0.36–0.95) .03 0.55 (0.31–0.95) .03 0.56 (0.30–1.03) .06 ≥3 0.94 (0.63–1.40) .75 0.42 (0.26–0.68) <.001 0.38 (0.21–0.68) .001 0.36 (0.19–0.69) .002 Analysis limited to women <65 years old with no history of hysterectomy (n = 740). All models included clinic as a random effect.
↵* Adjusted for total visit count in past 5 years only.
↵† Adjusted for age, marital status, ethnicity, body mass index (BMI) class, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, total number of visits in past 5 years.
↵‡ Adjusted for age, marital status, ethnicity, BMI class, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, total number of visits in past 5 years; limited to women with no digestive disease (n = 582).
- Table 5. Individual Chronic Disease's Effects on Being Up to Date for Cervical Cancer Screening According to US Preventive Services Task Force Guidelines
Chronic Diseases Up-to-Date Cervical Cancer Screening Status Unadjusted Bivariate OR (95% CI) P Value Adjusted OR (95% CI) for Demographics and Chronic Diseases* P Value Final Model,† OR (95% CI) P Value None 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) Arthritis 0.84 (0.60–1.18) .32 0.69 (0.46–1.03) .07 0.66 (0.45–0.97) .04 Asthma 1.06 (0.65–1.70) .82 0.90 (0.50–1.59) .71 Dropped Cardiovascular disease 0.71 (0.43–1.19) .19 0.59 (0.32–1.08) .09 Dropped Digestive disorders 1.04 (0.73–1.49) .81 0.70 (0.45–1.07) .10 Dropped Diabetes mellitus type 1 or 2 0.70 (0.47–1.07) .10 0.69 (0.39–1.20) .19 0.60 (0.36–0.98) .04 Depression/anxiety 1.24 (0.90–1.70) .18 1.07 (0.72–1.58) .74 Dropped Hypertension 0.65 (0.48–0.88) .006 0.57 (0.39–0.84) .004 0.53 (0.37–0.76) .001 Low-back pain 1.05 (0.73–1.50) .80 0.72 (0.47–1.12) .15 Dropped Analysis limited to women less than 65 years old with no history of hysterectomy, n = 740. All models included clinic as a random effect.
↵* Adjusted for age, marital status, ethnicity, body mass index classification, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, total number of visits in past 5 years, and the other chronic diseases.
↵† Adjusted for marital status, body mass index classification, total number of visits in past 5 years, asthma, cardiovascular disease, and digestive disorders.
- Table 6. Unadjusted and Adjusted Odds Ratios for Up-to-Date Colorectal Cancer Screening Status According to US Preventive Services Task Force Guidelines by Number of Chronic Conditions
Conditions (n) Up-to-Date for Colorectal Cancer Screening All Chronic Conditions Excluding Patients with Digestive Disorders Bivariate OR (95% CI) P Value Model 1,* Adjusted OR (95% CI) P Value Model 2,† Adjusted OR (95% CI) P Value Model 3,‡ Adjusted OR (95% CI) P Value Men (n = 1563) 0 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1 1.07 (0.73–1.56) .75 0.72 (0.47–1.10) .125 0.75 (0.48–1.18) .21 0.66 (0.41–1.05) .08 2 1.34 (0.93–1.93) .11 0.73 (0.48–1.09) .124 0.84 (0.53–1.31) .43 0.74 (0.46–1.20) .22 ≥3 1.44 (1.03–2.02) .03 0.61 (0.41–0.91) .016 0.75 (0.47–1.17) .20 0.54 (0.33–0.89) .02 Women (n = 1870) 0 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1 1.11 (0.79–1.56) .56 0.81 (0.57–1.17) .27 0.86 (0.58–1.26) .43 0.82 (0.54–1.23) .33 2 0.94 (0.67–1.31) .70 0.58 (0.40–0.83) .003 0.64 (0.43–0.95) .03 0.65 (0.42–0.99) .05 ≥3 1.37 (1.02–1.84) .04 0.62 (0.44–0.89) .008 0.69 (0.46–1.02) .06 0.60 (0.38–0.94) .03 ↵* Adjusted for total number of visits in past 5 years only. All models included clinic as a random effect.
↵† Adjusted for age, marital status, ethnicity, body mass index classification, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, and total number of visits in past 5 years.
↵‡ Adjusted for age, marital status, ethnicity, body mass index classification, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, total number of visits in past 5 years; limited to patients with no digestive disorders (men: n = 1232; women: n = 1385).
- Table 7. Unadjusted and Adjusted Individual Chronic Condition's Effect on Being Up to Date for Colorectal Cancer Screening According to US Preventive Services Task Force Guidelines
Conditions Up-to-date Colorectal Cancer Screening Status Unadjusted Bivariate OR (95% CI) P Value Demographics and Chronic Diseases, Adjusted OR (95% CI)* P Value Final Model, OR (95% CI)† P Value Men (n = 1563) No disease 1.0 (Referent) 1.0 (Referent) 1.0 (Referent) Arthritis 1.25 (0.99–1.58) .07 0.97 (0.74–1.27) .82 Dropped Asthma 1.12 (0.80–1.57) .51 1.01 (0.69–1.48) .96 Dropped Cardiovascular disease 0.77 (0.60–0.98) .04 0.59 (0.44–0.80) <.001 0.59 (0.44–0.79) <.001 Digestive disorders 2.07 (1.60–2.69) <.001 1.88 (1.40–2.52) <.001 1.83 (1.37–2.44) <.001 Diabetes mellitus type 1 or 2 0.88 (0.66–1.17) .37 0.77 (0.55–1.07) .12 Dropped Depression/anxiety 1.24 (0.87–1.49) .36 0.90 (0.65–1.23) .51 Dropped Hypertension 1.18 (0.95–1.47) .14 1.06 (0.81–1.38) .68 Dropped Low-back pain 1.29 (1.01–1.66) .04 1.00 (0.75–1.32) .98 Dropped Women (n = 1870) No disease 1.0 (Referent) 1.0 (Referent) 1.0 (Referent) Arthritis 1.18 (0.96–1.45) .11 0.83 (0.65–1.06) .13 Dropped Asthma 1.24 (0.93–1.65) .14 1.04 (0.76–1.43) .80 Dropped Cardiovascular disease 1.08 (0.85–1.38) .54 0.94 (0.71–1.26) .69 Dropped Digestive disorders 2.21 (1.77–2.75) <.001 1.72 (1.34–2.19) <.001 1.69 (1.33–2.15) <.001 Diabetes mellitus type 1 or 2 0.89 (0.67–1.17) .40 0.77 (0.56–1.06) .12 0.74 (0.54–1.01) .06 Depression/anxiety 1.02 (0.83–1.26) .84 0.71 (0.56–0.91) .006 0.69 (0.54–0.87) .002 Hypertension 1.04 (0.85–1.27) .70 0.90 (0.71–1.15) .40 Dropped Low-back pain 1.70 (1.36–2.13) <.001 1.29 (0.99–1.67) .06 Dropped ↵* Each disease was adjusted for age, marital status, ethnicity, body mass index classification, occupation, history of alcohol use, history of smoking, insurance status, length of contact with clinic, total number of visits in past 5 years, and the rest of the chronic diseases. All models included clinic as random effect.
↵† Men: adjusted for age, ethnicity, occupation, history of alcohol use, insurance status, length of contact with clinic, total number of visits in past 5 years, cardiovascular disease, and digestive disorders. Women: adjusted for age, marital status, ethnicity, body mass index classification, history of alcohol use, insurance status, length of contact with clinic, total number of visits in past 5 years, digestive disorders, depression, diabetes mellitus, and low-back pain.
