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Patient-Clinician Sex and Race and/or Ethnicity Concordance and Adherence to Preventive Services Guidelines: MEPS
Alexis L Green1, Randy Le1, Erik J Rodriquez2
1Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
Background:
Patient-clinician sex, racial, and ethnic concordance have been shown to improve healthcare utilization, but the impact of each on adherence to preventive services guidelines among specific populations remains unclear.
Objective:
To estimate the association between patient-clinician sex and racial and/or ethnic concordance and adherence to preventive services guidelines.
Design:
Cross-sectional study using nationally representative data from the Medical Expenditure Panel Survey (2018, 2020).
Participants:
Adults ≥ 18 years old who reported having a usual healthcare clinician. Adults who identified as multiracial, identified their clinician as being multiracial, or who did not report clinician sex, race, or ethnicity were excluded.
Main Measures:
Adherence to preventive services guidelines for influenza, pneumococcal, and shingles vaccines; breast, cervical, and colorectal cancer screening; and blood pressure and cholesterol screening. Predicted marginal prevalences and prevalence ratios were estimated using multivariable logistic regression, adjusting for sociodemographics, chronic conditions, and self-reported health status.
Key Results:
Females were less likely to report sex concordance compared to males (52.5% vs. 69.8%, p < 0.01). Among females, sex concordance increased influenza (PR = 1.08, 95% CI = 1.04-1.12), pneumococcal (PR = 1.06, 95% CI = 1.02-1.11), and shingles (PR = 1.09, 95% CI = 1.01-1.17) vaccination, as well as breast (PR = 1.06, 95% CI = 1.01-1.10), cervical (PR = 1.09, 95% CI = 1.05-1.13), and colorectal (PR = 1.07, 95% CI = 1.03-1.10) cancer screening, but not among males. Racial and/or ethnic concordance was low among American Indian and Alaska Native, Black, Latino, and Native Hawaiian and Pacific Islander patients (< 25%) and was not associated with adherence in preventive services.
Conclusions:
Females with female clinicians are more likely to adhere to preventive services guidelines. Racial and/or ethnic concordance was not associated with adherence to preventive services guidelines, but racial and/or ethnic concordance was low among non-White patients. Sex and racial and/or ethnic concordance may be a powerful tool for increasing preventive services utilization, but increased racial and/or ethnic concordance is needed to reach more definitive conclusions.
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