Yancy WS (Durham VAMC), McDuffie JR
(Durham VAMC), Stechuchak KM
(Durham VAMC), Olsen MK
(Durham VAMC), Datta SK
(Durham VAMC), Fisher DA
(Durham VAMC), Krause KM
(Duke University), Ostbye T
Previous research shows that obesity is related to lower utilization of certain clinical preventive services. This potential disparity has not been evaluated in the VA, where access to care is more uniform.
This retrospective cohort study used national VA data to assess receipt of adequate (target population and frequency of delivery per USPSTF) clinical preventive services in 1.7 million outpatients during 2000-2005. Unadjusted rates and adjusted odds ratios of receipt of service by BMI category were calculated for: screening for prostate (PSA), breast (mammography), cervical (Pap test), and colorectal (FOBT, barium enema, flexible sigmoidoscopy, colonoscopy) cancer, and vaccinations against influenza and pneumococcus.
The main cohort included 1,699,219 patients: 94% men, 48% white, and 38% unknown race. Screening rates for prostate cancer rose from 23% in underweight to 37% in obese class 2, but dropped to 35% in obese class 3. In men, colorectal cancer screening rose from 34% in underweight, and plateaued at 41-42% for the obese. In women, screening for breast (38-50%), cervical (67-75%) and colorectal (32-43%) cancer rose from underweight and plateaued among obese classes. Influenza vaccine increased linearly by BMI class from 18% to 25% in men and 16% to 23% in women. Starting with normal weight, pneumonia vaccine increased linearly from 32% to 38% in men and 28% to 35% in women; rates in underweight patients were 35% and 31% for men and women, respectively. Adjusted results were similar, with the highest odds ratios typically in the obese categories as compared to normal weight (referent category).
In a large national sample of veterans, obese patients received preventive services at a higher, not lower, rate than their normal weight peers. This may be due to the VA health service coverage and performance directives, a more homogeneous patient demographic profile, and/or unmeasured factors related to service receipt.
The VA health care system appears to have avoided disparities in receipt of preventive care related to obesity as seen elsewhere. The low overall rates of adequate service receipt deserve further examination; receipt of services outside the VA and the longitudinal (rather than cross-sectional) analysis are likely contributors.