Delivery of preventive services to adults aged 50-64: monitoring performance using a composite measure, 1997-2004

Abstract

Objective: Population-based rates for the delivery of adult vaccinations or screenings are typically tracked as individual services. The current approach is useful in monitoring progress toward national health goals but does not yield information regarding how many U.S. adults receive a combination of preventive services routinely recommended based on a person's age and gender. A composite measure is important for policymaking, for developing public health interventions, and for monitoring the quality of clinical care. During the period under study, influenza vaccination was newly recommended (2000) to be routinely delivered to adults in this age range. The objective of the study was to compare the delivery of routine clinical preventive services to U.S. adults aged 50-64 years between 1997 and 2004 using a composite measure that includes cancer screenings and vaccinations.

Design: Data were collected via telephone surveys in 1997, 2002, and 2004 as part of the Behavioral Risk Factor Surveillance System.

Participants: The participants were randomly selected adults aged 50-64 years in the 50 states and the District of Columbia in the selected years. Sample sizes ranged from 24,917 to 77,244.

Measurements and main results: The composite measure includes screening for colorectal cancer, cervical cancer, breast cancer, and vaccination against influenza (2002 and 2004 only). The composite measure quantifies the percentage of adults who are up-to-date with the complete set according to recommended schedules. With the inclusion of newly recommended influenza vaccination, the percentage of men and women aged 50-64 who were up-to-date on all selected measures in 2004 was 23.4% and 23.0%, respectively, compared with 37.6% and 30.5% in 1997. Without including influenza vaccination, the percentage of up-to-date adults aged 50-64 would have risen in 2004 to 50.5% (men) and to 44.7% (women). For both sexes, results varied by education, race/ethnicity, marriage status, insurance status, health status, and state.

Conclusion: In 2004, the percentage of adults aged 50-64 years receiving routinely recommended cancer screenings and influenza vaccination was low with fewer than 1 in 4 being up to date.