Routine preventive services for older women: A composite measure highlights gaps in delivery

Background: We used a composite measure to examine the delivery of routine clinical preventive services to U. S. women aged 50-64 years and >= 65 years in 2004. Methods: We analyzed state data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS) and created a composite measure that included screening of women >= 50 years for colorectal cancer, cervical cancer, breast cancer, vaccination against influenza, and, for women aged >= 65 years only, pneumococcal vaccination. The composite measure quantified the percentage of women who were up-to-date (UTD) according to recommended schedules for these services. Results: Approximately 23% of women aged 50-64 years and 32.5% of women aged >= 65 years were UTD in 2004. Results varied by education, race/ethnicity, marriage status, insurance status, and health status. There was also considerable geographic variation in state-specific UTD estimates, ranging from 16.7% (California) to 38.4% (Minnesota) for women aged 50-64 years and from 25.7% (Indiana) to 48.5% (Minnesota) for women aged >= 65 years. Conclusions: Although rates for some individual services were >= 75%, the percentage of women aged 50-64 years and >= 65 years UTD on all routinely recommended cancer screenings and vaccinations was low, with < 1 in 3 being UTD.