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Clinical Preventive Services

Disparities in Clinical Preventive Services

Explore the latest data for the LHI topic Clinical Preventive Services. 
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Where We’ve Been and Where We’re Going

From 2008 to 2010, the percentage of adults aged 50 to 75 years receiving a colorectal cancer screening based on the most recent guidelines increased 14%, from 52.1% (age adjusted) to 59.2%.

Over the past decade, blood pressure control increased by 55% among adults aged 18 years and over with hypertension from 31.6% (age adjusted) in 1999–2002 to 48.9% in 2009–2012.

Between 2005–2008 and 2009–2012, the rate of poor glycemic control (HbA1c greater than 9%) among adults aged 18 years and older with diagnosed diabetes increased 17%, from 17.9% to 21.0% (age adjusted); however, this change is not statistically significant.

The percentage of children aged 19 to 35 months who had received the recommended doses of DTaP, polio, MMR, Hib, Hep B, varicella, and PCV vaccines increased 54%, from 44.3% in 2009 to 68.4% in 2012. Differences in vaccination rates occur by education, income, and health insurance status.

Leading Health Indicators

Explore the latest data and disparities for each indicator.
Colorectal cancer screening (C-16)
Blood Pressure Control (HDS-12)
Poor Glycemic Control (D-5.1)
Fully Immunized Children (IID-8)

Colorectal cancer screening (C-16)

  • Healthy People 2020 objective C-16 tracks the proportion of adults who have had a blood stool test in the past year, sigmoidoscopy in the past 5 years and blood stool test in the past 3 years, or a colonoscopy in the past 10 years.
    • HP2020 Baseline: In 2008, 52.1% of adults aged 50 to 75 years received a colorectal cancer screening based on the most recent guidelines (age adjusted).
    • HP2020 Target: 70.5%, by modeling/projection.
  • Among racial and ethnic groups, the white non-Hispanic population had the highest rate of colorectal cancer screening based on the most recent guidelines in 2010, 61.6% of adults aged 50–75 years (age adjusted). When expressed as the proportion not receiving a colorectal cancer screening based on the most recent guidelines, rates for all other racial and ethnic groups were 14% to 42% higher than that of the white non-Hispanic population, although the disparity between those of 2 or more races and white non-Hispanics was not statistically significant.
  • In 2010, there was no statistically significant difference between females (59.1%, age adjusted) and males (59.3%, age adjusted) aged 50–75 years who had received a colorectal cancer screening based on the most recent guidelines.
  • Among education groups for persons aged 50–75 years, those with an advanced degree had the highest rate of colorectal cancer screening based on the most recent guidelines, 71.5% (age adjusted) in 2010. Rates for other education groups were:
    • 43.2% among those with less than a high school education (lowest rate)
    • 54.0% among those with a high school education or GED
    • 62.3% among those with some college education
    • 63.1% among those with an associates degree
    • 66.5% among those with a 4-year college degree
    • When expressed as adults aged 50–75 years not receiving a colorectal cancer screening based on the most recent guidelines, the rate for those with less than a high school education was about twice that of the population with an advanced degree.
  • Among income groups for persons aged 50–75 years, those with family incomes more than 600% of the poverty threshold had the highest rate of colorectal cancer screening based on the most recent guidelines, 72.9% (age adjusted) in 2010. Rates for other income groups were:
    • 38.7% among those with family incomes less than the poverty threshold (lowest rate)
    • 47.5% among those with family incomes between 100% and 199% of the poverty threshold
    • 57.4% among those with family incomes between 200% and 299% of the poverty threshold
    • 63.9% among those with family incomes between 300% and 399% of the poverty threshold
    • When expressed as adults aged 50–75 years not receiving a colorectal cancer screening based on the most recent guidelines, the rate for those with family incomes below the poverty threshold and between 100% and 199% of the poverty threshold was almost 2.5 times and almost twice that for those with family incomes more than 600% of the poverty threshold, respectively.
  • In 2010, persons aged 50–64 years with private health insurance had the highest rate of colorectal cancer screening based on the most recent guidelines, 61.4% (age adjusted) among insurance groups. Those with public insurance and the uninsured had rates of 55.3% and 21.0% (age adjusted), respectively. When expressed as adults aged 50–64 years not receiving a colorectal cancer screening based on the most recent guidelines, the rate for the uninsured population was about twice that for those with private health insurance.
Persons Not Receiving a Colorectal Cancer Screening by Insurance Status, 2010
Among persons aged 50-64 years, the rate for uninsured population was about twice that for those with private health insurance.
 

SOURCE: National Health Interview Survey (NHIS), CDC/NCHS.

Endnotes:

  • All disparities described are statistically significant at the 0.05 level of significance. To maintain comparability across indicators, disparities are computed using adverse events.
  • Data are age adjusted to the 2000 standard population using the age groups 50–64 and 65–75 years. Age-adjusted rates are weighted sums of age-specific rates.
  • Data for this measure are available periodically and come from the National Health Interview Survey (NHIS), CDC, NCHS.
  • U.S. Preventative Services Task Force (USPSTF) guidelines recommend screening for colorectal cancer using fecal occult blood testing annually, sigmoidoscopy 5 years with fecal occult blood testing every 3 years, or colonoscopy 10 years for persons aged 50 to 75 years.

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Blood Pressure Control (HDS-12)

  • Healthy People 2020 objective HDS-12 tracks the proportion of adults with hypertension whose blood pressure is under control (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg).
    • HP2020 Baseline: In 2005–2008, 43.7% of adults aged 18 years and older with hypertension had it under control (age adjusted).
    • HP2020 Target: 61.2%, a 40% improvement over the baseline.
    • The percentage of adults aged 18 years and over with hypertension who had their blood pressure under control increased by 55% between 1999–2002 and 2009–2012, from 31.6% to 48.9% (age adjusted).
  • Among racial and ethnic groups, the white non-Hispanic population had the highest rate of blood pressure control, 53.6% of persons aged 18 years and over with hypertension (age adjusted) in 2009–2012, whereas the Hispanic population had a rate of 37.9% (age adjusted) in 2009–2012, and the black non-Hispanic population had a rate of 44.1% (age adjusted). When expressed as adults with hypertension whose blood pressure is uncontrolled, the rate for the Hispanic populations was almost 1.5 times that of the white non-Hispanic population.
  • Females had a higher (better) rate of blood pressure control than males (56.6% versus 43.1%, age adjusted) in 2009–2012. When expressed as adults with hypertension whose blood pressure is uncontrolled, the rate for males was almost 1.5 times the rate for females.
Uncontrolled Blood Pressure by Sex, 2009–12
The rate for males was almost 1.5 times the rate for females

SOURCE: National Health and Nutrition Examination Survey (NHANES), CDC/NCHS.

  • Persons aged 20 years and over with activity limitations had a higher (better) rate of blood pressure control than persons without activity limitations (63.1% versus 45.3%, age adjusted) in 2009–2012.
  • Persons aged 45 to 64 years had the highest rate of blood pressure control, 56.6% in 2009–2012, among broad age groups with hypertension. Rates for the other age groups were:
    • 39.1% among persons aged 18–44; nearly 1.5 times the best group rate when expressed as adults with hypertension whose blood pressure is uncontrolled
    • 52.5% among persons aged 65 years and over (no statistically significant difference)
  • When further refining the age groups, persons aged 65–74 years had the highest rate of blood pressure control, 58.5% in 2009–2012. Rates for the other age groups were:
    • 41.3% among persons aged 25–44 years; nearly 1.5 times the best group rate when expressed as adults with hypertension whose blood pressure is uncontrolled
    • 57.9% among persons aged 45–54 years (no statistically significant difference)
    • 55.7% among persons aged 55–64 years (no statistically significant difference)
    • 52.3% among persons aged 75–79 years (no statistically significant difference)
    • 41.5% among persons aged 80 years and over
  • Adults with hypertension born in the United States had a higher (better) rate of blood pressure control than persons born outside the United States (50.2% versus 41.2%, age adjusted) in 2009–2012.
  • Among health insurance status groups, persons aged 18–64 years with hypertension with public health insurance had the highest rate of blood pressure control, 54.6% (age adjusted) in 2009–2012, whereas persons with private insurance had a rate of 51.4% (no statistically significant difference) and persons with no health insurance had a rate of 30.9% (age adjusted). When expressed as adults with hypertension whose blood pressure is uncontrolled, the rate for persons with no health insurance was about 1.5 times the rate for persons with public health insurance.
  • In 2009–2012, adults with hypertension with diabetes had a higher (better) rate of blood pressure control than persons without diabetes (67.2% versus 45.9%, age adjusted). When expressed as adults with hypertension whose blood pressure is uncontrolled, the rate for persons without diabetes was more than 1.5 times the rate for persons with diabetes.
  • In 2009–2012, adults aged 20 years and over with hypertension who were obese had a higher (better) rate of blood pressure control than persons who were not obese (54.8% versus 42.4%, age adjusted).

Endnotes:

  • Unless otherwise stated, all comparisons described are statistically significant at the 0.05 level of significance.
  • Data for this measure are available biennially and come from the National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Preferably 4 years of data are pooled for analysis when available.
  • The terms “Hispanic or Latino” and “Hispanic” are used interchangeably in this report.
  • Data (except those by disability status, education status, health insurance coverage, obesity status, and age group) are age adjusted to the 2000 standard population using the age groups 18–49, 50–59, 60–69, 70–79, and 80 years and over. Data by disability and obesity status are adjusted using the age groups 20–49, 50–59, 60–69, 70–79, and 80 years and over. Data by education status are adjusted using the age groups 25–49, 50–59, 60–69, 70–79, and 80 years and over. Data by health insurance coverage are adjusted using the age groups 18–49, 50–59, and 60–64 years. Data by age group are not age adjusted. Age-adjusted rates are weighted sums of age-specific rates.
  • Blood pressure control is defined as an average systolic blood pressure <140 mmHg and an average diastolic blood pressure <90 mmHg among adults with hypertension. Hypertension is defined as an average systolic blood pressure ≥140 mmHg, an average diastolic blood pressure ≥90 mmHg, or self-reported current use of blood pressure lowering medication. Pregnant women are excluded from analyses.

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Poor Glycemic Control (D-5.1)

  • Healthy People 2020 (HP2020) objective D-5.1 tracks the proportion of adults with diagnosed diabetes who have poor glycemic control (HbA1c greater than 9%).
    • HP2020 Baseline: In 2005–2008, 17.9% of adults aged 18 years and over with diagnosed diabetes had poor glycemic control (age adjusted).
    • HP2020 Target: 16.1%, a 10% improvement over the baseline.
  • Among racial and ethnic groups with diagnosed diabetes, the white non-Hispanic population had the lowest rate of poor glycemic control, 15.3% of persons aged 18 years and over (age adjusted) in 2009–2012. Rates for other race/ethnicity groups were nearly twice the best rate (age-adjusted):
    • 28.5% among the black or African American, non-Hispanic population
    • 28.1% among the Hispanic population
  • Persons with diagnosed diabetes aged 65 years and over had the lowest rate of poor glycemic control among age groups, 8.0% in 2009–2012. Rates for the other age groups were:
    • 14.4% among persons aged 45–64 years; nearly 2 times the best group rate
    • 30.3% among persons aged 18–44 years; nearly 4 times the best group rate
  • Comparisons for 2009–2012 among sex, educational attainment, family income, country of birth, disability status, health insurance status, marital status, and obesity status groups were not statistically significant.

Endnotes:

  • Unless otherwise stated, all comparisons described are statistically significant at the 0.05 level of significance.
  • Data for this measure are available biennially and come from the National Health and Nutrition Examination Survey (NHANES), CDC/NCHS. Preferably 4 years of data are pooled for analysis when available.
  • The terms “Hispanic or Latino” and “Hispanic” are used interchangeably in this report.
  • 2009–2012 data (except those by education status, health insurance coverage, obesity status, marital status, disability status, and age group) are age adjusted to the 2000 standard population using the age groups 18–49, 50–59, 60–69, 70–79, and 80 years and over. Data by education status are adjusted using the age groups 25–49, 50–59, 60–69, 70–79, and 80 years and over. Data by health insurance coverage are adjusted using the age groups 18–49, 50–59, and 60–64 years. Data by obesity status, disability status, and marital status are age adjusted using the groups 20–49, 50–59, 60–69, 70–79, and 80 years and over.
  • Data by age group are not age adjusted. Age-adjusted rates are weighted sums of age-specific rates.
  • The age distribution of the year 2000 standard population used for age adjustment may not be sufficiently similar to the age distribution for the population with diagnosed diabetes.
  • Diagnosed diabetes is self-reported based on the question, “Have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?” Women who reported having diabetes only during pregnancy and persons who report being diagnosed as having “borderline” diabetes are excluded.

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Fully Immunized Children (IID-8)

  • Healthy People 2020 (HP2020) objective IID-8 tracks the proportion of children aged 19 to 35 months who have received the recommended doses of diphtheria, tetanus, and pertussis (DTaP); polio; measles, mumps, and rubella (MMR); Haemophilus influenzae type b (Hib); hepatitis B (Hep B); varicella; and pneumococcal conjugate vaccine (PCV) vaccines.
    • HP2020 Baseline: In 2009, 44.3% of children aged 19 to 35 months had received the recommended doses of DTaP, polio, MMR, Hib, Hep B, varicella and PCV vaccines.
    • HP2020 Target: 80%, consistent with national programs.
  • Among racial and ethnic groups, Asian children aged 19 to 35 months had the highest rate of complete vaccination, 71.7% in 2012, whereas black or African-American children had a rate of 64.8%. However, the difference between these rates was not statistically significant.
  • The difference in rates of complete vaccination by sex was not statistically significant (67.7% for females versus 68.9% for males).
  • Children of mothers aged 25 years and over with an advanced degree had the highest rate of complete vaccination (76.4%) among education groups, while children of mothers with less than a high school education had a rate of 63.4%. When expressed as children not having received the complete series of vaccinations, the rate for children whose mothers had less than a high school education was about 1.5 times higher than that for children of mothers with an advanced degree.

Children Not Fully Immunized by Mother’s Education, 2012

 

The rate for children aged 19-35 months whose mothers had less than a high school education was 55% higher than that for children of mothers with an advanced degree.

Data Source: National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS.

  • Children in families with incomes of 400–599% of the poverty threshold had the highest rate of complete vaccination (77.7%) among income groups. Rates for children in other income groups were:
    • 63.6% for those with family incomes under the poverty threshold
    • 68.2% for those with family incomes 100% to 199% of the poverty threshold
    • 68.2% for those with family incomes 200% to 399% of the poverty threshold
    • 77.1% for those with family incomes 600% or more of the poverty threshold
    • When expressed as children not having received the complete series of vaccinations, the rate for children with family incomes under the poverty threshold was more than 1.5 times higher than that for children with family incomes of 400–599% of the poverty threshold.
  • Children with private health insurance had the highest rate of complete vaccination (73.2%) among insurance groups. Rates for children in other insurance groups were:
    • 64.7% for those with public insurance
    • 51.2% for those without insurance
    • When expressed as children not having received the complete series of vaccinations, the rate for children without health insurance was almost twice the rate of those with private health insurance.

Endnotes:

  • All disparities described are statistically significant at the 0.05 level of significance. To maintain comparability across indicators, disparities are computed using adverse events.
  • Data for this measure are available annually and come from the National Immunization Survey (NIS), CDC/NCIRD and CDC/NCHS.
  • Public and private insurance are not mutually exclusive. About 5% of children with health insurance are included in both categories.
  • Complete vaccination is defined as receipt of the following recommended doses of each of the following vaccines: 4 DTap, 3 polio, 1 MMR, 3 or 4 Hib (depending on product type received, including primary series plus the booster dose), 3 Hep B, 1 varicella, and 4 PCV.
  • Some children in the baseline (2009) NIS sample were affected by the Hib vaccine shortage and thus not recommended to get the full Hib series.

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