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BACKGROUND/RATIONALE:
Obesity is a burgeoning public health problem in the United States population and in veterans specifically. A few studies have shown that while obese patients utilize health care at higher rates than their normal weight counterparts, they may be less likely to receive certain preventive services. The general quality of overall preventive health care that obese Americans, and obese veterans in particular, receive has not been examined extensively.
OBJECTIVE(S):
Using national Veterans Affairs (VA) medical facilities data, we will determine whether important preventive services, including screening for prostate (prostate-specific antigen [PSA]), breast (mammography), cervical (Papanicolaou [Pap] smear test), and colon (fecal-occult blood test [FOBT], barium enema, flexible sigmoidoscopy, or colonoscopy) cancer, and vaccination against influenza and pneumonia, are received less frequently by overweight and obese American veterans than by those of normal weight.
METHODS:
Design: Retrospective cohort study using national VA administrative and medical databases.
Setting: 136 VA hospitals and outpatient clinics in the United States.
Participants: A cohort of 1.8 million veterans with one or more visits to national VA outpatient clinics in the year 2000.
Main Outcome Measures: Receipt of the following key preventive services in the recommended populations: screening for prostate (PSA), breast (mammography), cervical (Pap smear test), and colon (FOBT, barium enema, flexible sigmoidoscopy, or colonoscopy) cancer, and vaccination against influenza and pneumonia over the follow-up period 2000-2004.
Analyses: Bivariate analyses of the relationships between body mass index (BMI) and receipt of the preventive services. Multivariable analyses of the same relationships adjusting for sociodemographic, health, and health care factors.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Compared with those of normal weight, obese patients are at increased risk for a number of cancers, and for adverse outcomes from certain vaccine preventable infections. Obese veterans may be, in spite of their higher risk, less likely to receive preventive services for these diseases. This disparity may contribute significantly to the excess morbidity and mortality that occurs in obese patients compared with non-obese patients. The identified datasets provide a unique opportunity for not only determining whether and the extent to which overweight and obese veterans are less likely to receive key preventive services for these diseases, but may also suggest potential explanations for these disparities. Further, because obese patients may have reduced access to care in the general population, data from patients seen in the VA healthcare system, where access to care is more equitable, should be ideal for examining this issue. If the disparities are present, our findings should direct us toward specific areas to better explain these disparities and subsequently suggest clinical and health policy interventions that could reduce these disparities in care.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Resource Use and Cost
Keywords:
Utilization patterns, Obesity
MeSH Terms:
none
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