The Underuse of Screening Services Among Elderly Women with Diabetes

Abstract

OBJECTIVE: To determine if the use of non-diabetes-related preventive services (mammography, colorectal cancer screening and bone density testing) among elderly diabetic women is different than the use among women without diabetes.

RESEARCH DESIGN AND METHODS: Using a representative sample of the U.S. elderly female population, the linked SEER/Medicare files, we identified women with or without diabetes who were ≥ 67 years of age on January 1, 1999. All women with a prior history of cancer were excluded. Bivariate and multivariate analyses were employed to compare the rates of preventive service use and understand the factors influencing their use in the next two to four years.

RESULTS: Women with diabetes were less likely to have a mammogram (OR = 0.83, 95% CI: 0.78 -- 0.88), colorectal cancer screening (OR = 0.79, 95% CI: 0.70 -- 0.88), and bone density testing (OR = 0.63, 95% CI: 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 to not receiving these services may be needed in order to achieve parity.