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

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.