Primary Care Research

Poverty-related factors rather than frequency of primary care visits underlie racial disparities in preventive care

Elderly black and Hispanic patients receive fewer preventive care services such as cancer screening and vaccinations than elderly whites. Poverty-related factors, such as lack of insurance and low income and education, appear to underlie more of this disparity than fewer primary care visits, which appear to contribute minimally to these disparities.

Kevin Fiscella, M.D., M.P.H., and Kathleen Holt, Ph.D., of the University of Rochester School of Medicine and Dentistry, analyzed 1998-2002 Medicare claims data on receipt of five preventive care services: colorectal cancer testing, influenza vaccination, lipid screening, mammography, and Pap smear screening for cervical cancer.

Minorities had statistically lower rates of claims for each of the five preventive procedures, after adjusting for age. The effect of minority status was only slightly weakened after controlling for the number of primary care visits made by patients. Yet, after accounting for low income, low educational level, health status, and other poverty-related factors, minority status was significantly associated only with colorectal cancer screening (21 percent lower rate) and influenza vaccinations (44 percent lower rate).

The researchers suggest that patient recall systems can help target elderly patients overdue for preventive services. Also, longer office visits may be needed to work with impoverished patients to confirm their understanding and address financial barriers to adherence to therapy. Finally, newer reimbursement models are needed that take into account the increased costs (and time) of caring for poor patients.

The study was supported by the Agency for Healthcare Research and Quality (HS13173).

See "Impact of primary care patient visits on racial and ethnic disparities in preventive care in the United States," by Drs. Fiscella and Holt, in the November-December 2007 Journal of the American Board of Family Medicine 20(6), pp. 587-597.

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