Table 4.

Adjusted Odds Ratios for Quality of Chronic and Preventive Care by Cold Spot Designation

Cold Spot Designation
PovertyLow EducationSocial Deprivation Index
OR95% CIOR95% CIOR95% CI
Chronic conditions
    Uncontrolled diabetes1.060.89––1.381.120.93–1.35
Preventive measures
    Prostate cancer0.8*0.71–0.900.83*0.73–0.920.910.79–1.03
    Pneumonia vaccination1.13*1.07–1.201.24*1.17–1.311.15*1.08–1.22
    Colon cancer screening0.88*0.83–0.930.87*0.82–0.920.89*0.83–0.95
    Cervical cancer screening1.13*1.07–1.191.17*1.11–1.231.18*1.11–1.24
  • CI, confidential interval; OR, odds ratio.

  • * ORs are significantly different from 1 (P < .05).

  • The full multivariable model did not converge, so the practice random effect was excluded. Adjusted for age (estimates provided at age = 42.5 years), gender, race, and ethnicity. Cold spots are defined as those census tracts in the highest quartiles for poverty, low education, and composite social deprivation. Poverty is measured by the percentage earning less than 200% of the federal poverty level. Low education is measured by the percentage without a high school diploma or General Education Development. The Social Deprivation Index is a composite measure of community material and social deprivation and is a score from 0 to 100. Obesity was defined as those with a body mass index of 30 or more. Uncontrolled diabetes was defined as those with a hemoglobin A1c of 9 or more.

  • We assessed pneumonia vaccination by determining whether those 65 years or older had one dose of the 23- or 13-valent pneumococcal vaccine, colorectal cancer screening by determining whether those aged 50 to 75 year had a colonoscopy within the past 10 years or a fecal occult blood test within the past year, cervical cancer screening by determining whether those aged 21 to 65 had a pap smear within the past 3 years or those aged 30 to 65 had a pap smear human papilloma virus testing within the past 5 years, prostate cancer screening by whether men aged 55 to 70 had a prostate specific antigen performed within the past 2 years (excluding those with personal or family histories of prostate cancer, and African Americans), and aspirin use by determining whether those with a diagnosis of heart disease, congestive heart failure, or peripheral vascular disease had aspirin prescribed.