Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington 98101, USA.
Am J Prev Med. 2011 Nov;41(5):465-72. doi: 10.1016/j.amepre.2011.07.020.
Reports from the 1990s observed lower receipt of preventive care services among obese individuals, but a few recent studies in older adults and Department of Veterans Affairs (VA) patients have failed to do so. Additional studies, using population-based samples, are needed to understand whether disparities in care by obesity continue to exist in the U.S.
To investigate whether receipt of preventive care services varies in relation to BMI.
This study used data from the 2008 and 2009 Behavioral Risk Factor Surveillance System (analyzed in 2011), a state-based national telephone survey of non-institutionalized U.S. adults, to examine associations between receipt of preventive services (influenza and pneumococcal vaccination; cholesterol and HIV screening; fecal occult blood test; colonoscopy/sigmoidoscopy, mammogram, and Pap) and BMI category (normal, 18.5-24.9; overweight, 25-29.9; obese Class I, 30-34.9; obese Class II, 35-39.9; and obese Class III, ≥40), after adjusting for confounding factors.
Receipt was lower for mammography and Pap testing (6.1 and 5.6 percentage points, respectively, relative to normal weight women) in obese Class III women. For immunizations, cholesterol screening, and colon cancer screening, receipt was similar or greater in overweight and obese individuals.
This study suggests that for most services, obese individuals received as much if not more preventive health care as normal-weight individuals. Although these findings are reassuring, the evidence for disparities for cervical and breast cancer screening in obese women demonstrates that efforts to ensure more equitable service delivery are still needed.
上世纪 90 年代的报告指出，肥胖人群接受预防保健服务的比例较低，但最近几项针对老年人和退伍军人事务部（VA）患者的研究并未发现这一现象。需要更多基于人群的研究来了解美国肥胖人群在医疗保健方面的差距是否仍然存在。
调查接受预防保健服务的情况是否与 BMI 有关。
本研究使用了 2008 年和 2009 年行为风险因素监测系统（于 2011 年进行分析）的数据，该系统是一项基于州的美国非机构化成年人全国电话调查，旨在研究接受预防服务（流感和肺炎球菌疫苗接种；胆固醇和 HIV 筛查；粪便潜血试验；结肠镜检查/乙状结肠镜检查、乳房 X 光检查和巴氏涂片）与 BMI 类别（正常体重，18.5-24.9；超重，25-29.9；肥胖一级，30-34.9；肥胖二级，35-39.9；肥胖三级，≥40）之间的关联，同时调整了混杂因素。
肥胖三级女性接受乳房 X 光检查和巴氏涂片检查的比例较低（分别低 6.1 和 5.6 个百分点）。在超重和肥胖人群中，接受免疫接种、胆固醇筛查和结肠癌筛查的比例相似或更高。
本研究表明，对于大多数服务，肥胖个体接受的预防保健与正常体重个体一样多，如果不是更多的话。尽管这些发现令人欣慰，但肥胖女性在宫颈癌和乳腺癌筛查方面存在差异的证据表明，仍需要努力确保更公平的服务提供。
