摘要：Objectives . We examined the effect of demographic and socioeconomic factors on use of preventive services (prostate-specific antigen testing, colorectal cancer screening, and influenza vaccination) among elderly men enrolled in 2 Medicare+Choice health plans. Methods . Data were derived from administrative files and a survey of 1915 male enrollees. We used multivariate logistic regression to assess the effects of enrollee characteristics on preventive service use. Results . Age, marital status, educational attainment, and household wealth were associated with receipt of one or more preventive services. However, the effects of these variables were substantially attenuated relative to earlier studies of Medicare. Conclusions . Some Medicare HMOs have been successful in attenuating racial and socioeconomic disparities in the use of preventive services by older men. Delivery of clinical preventive services to older adults can reduce premature morbidity and mortality while preserving functioning and enhancing quality of life. 1 Currently, the US Preventive Services Task Force recommends annual influenza vaccinations starting at the age of 65 years and colorectal cancer (CRC) screening starting at 50 years. 2, 3 Although not universally endorsed, annual prostate-specific antigen (PSA) testing is increasingly used by physicians to screen for prostate cancer. 4 Most major medical organizations recommend that physicians discuss with patients the potential benefits and harms of PSA testing and individualize the decision to screen. 5 The most appropriate candidates for PSA screening are men older than 50 years with a life expectancy of 10 years. Previous studies have shown that race and socioeconomic status are important determinants of the use of preventive services by Medicare beneficiaries enrolled in traditional fee-for-service Medicare. 6– 12 For example, one study showed that Black beneficiaries in fee-for-service Medicare were 39% less likely than White beneficiaries to receive an influenza vaccination. 6 Other studies have shown that low-income beneficiaries are 26% to 39% less likely than high-income beneficiaries to receive an influenza vaccination and that poor elderly men are 29% less likely than more affluent seniors to undergo prostate cancer screening. 6, 7 Overall, Medicare beneficiaries enrolled in HMOs are more likely than those enrolled in fee-for-service plans to undergo cancer screening or receive an influenza vaccination. 8, 13, 14 However, only a few studies have assessed socioeconomic and racial disparities in the use of preventive services in Medicare HMOs. Schneider et al. 9 found disparities in breast cancer screening by race, education, and income in their study of a national sample of Medicare HMOs. Scott et al. 10 found that, among Medicare HMO enrollees, race/ethnicity and inadequate health literacy were independently associated with never having received an influenza vaccination. Schneider et al. 8 found that White Medicare beneficiaries were substantially more likely than Blacks to receive an influenza vaccination and that there were no differences in terms of racial disparities between Medicare HMOs and traditional Medicare fee for service. In the present study, we investigated the effects of racial and socioeconomic factors on the use of 3 preventive services (PSA testing, CRC screening, and influenza vaccination) among elderly men enrolled in 2 Medicare+Choice HMOs.
