Vulnerability and the receipt of recommended preventive services: The influence of multiple risk factors

Leiyu Shi, Gregory D. Stevens

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Context: Previous studies have confirmed the independent associations of race/ethnicity, socioeconomic status, and potential access with the receipt of preventive care. More pragmatic models of vulnerability are needed to examine the concomitant influence of multiple risk factors. Objective: To operationalize vulnerability as risk profiles of predisposing (race/ethnicity and education) and enabling (eg, income, health insurance, and having a regular source of care) factors, and their association with the receipt of preventive care. Study Design: Cross-sectional data on 14,983 adults from the Household Component of the 1996 Medical Expenditure Panel Survey. Main Outcome Measures: Receipt of recommended preventive care: blood pressure and cholesterol screening, flu shot, Papanicolaou test, mammogram, and dental visit. Results: Controlling for other factors, analyses of risk profiles revealed a clear dose-response relationship with the receipt of preventive care regardless of race/ethnicity. In the total sample, having more risk factors was associated with a lower prevalence of, for example, receiving a cholesterol screening: 1 risk (PR = 0.77; CI. 0.71-0.84), 2 risks (PR = 0.56; CI, 0.49-0.64), and 3+ risks (PR = 0.34; CI, 0.25-0.43). Conclusion: Sizeable disparities in the receipt of recommended preventive services were found in relation to increasing vulnerability risk profiles. Without attention to such co-occurring risks, it is unlikely that substantial gains will be made in reducing disparities in the incidence of and mortality from the most common preventable diseases in the United States.

Original languageEnglish (US)
Pages (from-to)193-198
Number of pages6
JournalMedical care
Issue number2
StatePublished - Feb 1 2005


  • Disparities
  • Preventive care
  • Race/ethnicity
  • Socioeconomic status
  • Vulnerability

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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