The Effect of Economic and Social Conditions on the Use of Clinical Preventive Services

This study examines the relationship between economic conditions and individuals’ use of clinical preventive (CP) services. CP services form the cornerstone of the national healthcare agenda, and are key in the fight to reduce morbidity and mortality in the United States. Despite this, low utilization rates remain concerning, with recent statistics indicating that rates of CP service use fall well below the targets outlined in Healthy People 2020. In the present study, I focus on individuals’ use of three CP services, influenza vaccinations, blood cholesterol screening, and endoscopic colorectal cancer screening. Broadly, I examine the effect of state-level unemployment and income inequality on individuals’ use of these services. I also explore underlying social mechanisms that may shape these behaviors. Specifically, I examine how social contextual factors, state-level social capital and health-related resources, affect individuals’ use of CP services net of individual-level characteristics. The data from this study is derived from a variety of sources. Contextual-level data is obtained from the Bureau of Labor Statistics, Mark W. Frank’s Income Inequality Measures, the General Social Survey, the Association of American Medical Colleges, the Current Population Survey, and the Centers for Disease Control and Prevention. Individual-level data is obtained from the 2010 and 2011 Behavioral Risk Factor Surveillance System. I use multilevel models to examine how contextual factors shape individuals’ use of CP services. I also include a range of individual-level variables to capture the socio-demographic, economic, lifestyle, and health-related characteristics that shape individuals’ use of CP services. Findings suggest that the relationships between state-level economic and social factors, and CP services differ by the specific CP service examined. Specifically, results suggest the state-level unemployment and income-inequality are significantly and negatively associated with individuals’ use of influenza vaccinations, after taking into account individual-level characteristics. Findings also reveal that state-level unemployment is significantly and positively associated with individuals’ use of blood cholesterol screening and endoscopic colorectal cancer screening. Additionally, results indicate that some social conditions also shape individuals’ use of CP services. Specifically, confidence in the media is a salient predictor of individuals’ use of influenza vaccinations, blood cholesterol screening, and endoscopic colorectal cancer screening. Social trust is an important predictor of individuals’ use of endoscopic colorectal cancer screening. Health-related resources, specifically primary care physician supply and participation in the Colorectal Cancer Control Program, are also salient predictors of individuals’ use of endoscopic colorectal cancer screening. Findings also point to significant relationships between individual-level variables and use of CP services. Broadly, across all CP services examined, socio-demographic and economic (e.g. age, gender, income, employment status) and health-related factors, particularly health insurance and health status, are salient in predicting individuals’ use of CP services. Most of the existing research on CP service use focuses on individual-level determinants of use, and broader economic and social conditions are frequently ignored. Findings from the current study suggest that contextual economic and social factors impact individuals’ decisions to use CP services net of individual-level factors. Thus, efforts should be made to address the contextual economic and social features of the environment that shape individuals’ use of CP services