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The Underuse of Screening Services Among Elderly Women With Diabetes

From the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota

Address correspondence and reprint requests to A. Marshall McBean, MD, MSc, Division of Health Policy and Management, University of Minnesota School of Public Health, MMC 97, 420 Delaware St., SE, Minneapolis, MN 55455. E-mail: mcbea002{at}umn.edu

OBJECTIVE—To determine whether the use of nondiabetes-related preventive services (mammography, colorectal cancer screening, and bone density testing) among elderly diabetic women is different from the use among nondiabetic women.

RESEARCH DESIGN AND METHODS—Using a representative sample of the U.S. elderly female population and the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare files, we identified women with or without diabetes who were 67 years of age on 1 January 1999. All women with a prior history of cancer were excluded. Bivariate and multivariate analyses were used to compare the rates of preventive service use and to understand the factors influencing their use in the next 2–4 years.

RESULTS—Women with diabetes were less likely to have a mammogram (odds ratio [OR] 0.83 [95% CI 0.78–0.88]), colorectal cancer screening (0.79 [0.70–0.88]), and bone density testing (0.63 [0.58–0.69]). Women with diabetes seen by endocrinologists had significantly higher rates of bone density testing than women seen by primary care physicians. Women seen by obstetrician/gynecologists had the highest rates of use of all three services.

CONCLUSIONS—Elderly women with diabetes are less likely to receive cancer and osteoporosis screening than women without diabetes. Physicians treating these patients need to assure that they receive all recommended preventive services appropriate for their age. Additional national guidelines, practice-based improvements, and patient education targeting those at greatest risk of not receiving these services may be needed to achieve parity.

Abbreviations: ADA, American Diabetes Association • CDC, Centers for Disease Control and Prevention • CMS, Centers for Medicare and Medicaid Services • HCPCS, Healthcare Common Procedure Coding System • SEER, Surveillance, Epidemiology, and End Results

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