标题：Associations Between Obesity and Receipt of Screening Mammography, Papanicolaou Tests, and Influenza Vaccination: Results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study
摘要：Objectives. Obese Americans, who receive more care for chronic diseases, may receive fewer preventive services. We evaluated the association between body mass index (BMI) and receipt of screening mammography and Papanicolaou tests among middle-aged women and the association between BMI and receipt of influenza vaccination among the elderly. Methods. We analyzed 2 datasets: the Health and Retirement Study (4439 women aged 50–61 years) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study (4045 women and 2154 men aged 70 years or more). Results. When BMI was greater than 18.5 kg/m2, we found an inverse dose-response relationship between BMI and receipt of screening mammography and Pap tests among White, but not Black, middle-aged women. We found a similar association between BMI and influenza vaccination among the elderly. Conclusions. Higher BMI was associated with less frequent receipt of preventive services among middle-aged White women and elderly White women and men. The Healthy People 2010 clinical preventive service goals remain elusive, especially for overweight and obese White persons. More than 60% of US adults are overweight or obese. 1 The role of obesity as a risk factor for morbidity and mortality is well-documented, 2 – 4 including its substantial economic costs. 5 – 7 In addition to health and economic burdens, obese persons experience important personal and social consequences. 8 , 9 They may pay higher premiums for life insurance, earn less income, and be less likely to be hired or promoted than non-obese persons. 6 – 9 Little research has been carried out on the association between disparities in health care service use and body weight. Obese persons have more physician visits, receive more prescriptions, and incur more health care costs than non-obese persons. 5 , 10 However, there is evidence that obese persons receive fewer clinical preventive services. 11 In the 1994 National Health Interview Survey, fewer overweight and obese women (78%) compared with women of recommended weight (84%) had received cervical cancer screening during the previous 3 years; significantly lower rates also were seen for mammography screening among overweight and obese women aged 50 to 75 years. 12 It is not clear whether similar patterns hold for preventive services among the elderly, who receive universal health coverage through Medicare. Epidemiological studies of influenza vaccination often do not consider obesity as a study variable, although a brief report on elderly persons in the 1987 Behavioral Risk Factor Surveillance System identified obesity as a predictor of not being vaccinated. 13 Additionally, obesity is more prevalent among Black persons than among White persons, 1 and there are racial disparities in access to and quality of health care services in general. 14 Therefore, we investigated whether the association between obesity and receipt of clinical preventive services is different among Black and White persons. There is strong evidence that breast and cervical cancer screening is beneficial among middle-aged women and that influenza vaccination benefits the elderly. 15 Healthy People 2010 16 goals include (1) having 70% of middle-aged women receive mammograms every 2 years and 90% receive Papanicolaou (Pap) tests every 3 years, and (2) having 90% of the elderly immunized against influenza annually. There also is evidence that obese post-menopausal women are at increased risk for breast and cervical cancer and that they present with more advanced disease. 17 , 18 Similarly, obesity is associated with diabetes and chronic cardiopulmonary diseases, which are associated with increased morbidity and mortality from influenza. 19 We evaluated the association between body mass index (BMI) and receipt of screening mammography and Pap tests among middle-aged women and the association between BMI and influenza vaccination among the elderly. We also evaluated whether these associations vary by race and whether the associations have changed over time.
