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Variation in Receipt of Cancer Screening and Immunizations by 10-year Life Expectancy among U.S. Adults aged 65 or Older in 2019

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Abstract

Importance

The likelihood of benefit from a preventive intervention in an older adult depends on its time-to-benefit and the adult’s life expectancy. For example, the time-to-benefit from cancer screening is >10 years, so adults with <10-year life expectancy are unlikely to benefit.

Objective

To examine receipt of screening for breast, prostate, or colorectal cancer and receipt of immunizations by 10-year life expectancy.

Design

Analysis of 2019 National Health Interview Survey.

Participants

8,329 non-institutionalized adults >65 years seen by a healthcare professional in the past year, representing 46.9 million US adults.

Main Measures

Proportions of breast, prostate, and colorectal cancer screenings, and immunizations, were stratified by 10-year life expectancy, estimated using a validated mortality index. We used logistic regression to examine receipt of cancer screening and immunizations by life expectancy and sociodemographic factors.

Key Results

Overall, 54.7% of participants were female, 41.4% were >75 years, and 76.4% were non-Hispanic White. Overall, 71.5% reported being current with colorectal cancer screening, including 61.4% of those with <10-year life expectancy. Among women, 67.0% reported a screening mammogram in the past 2 years, including 42.8% with <10-year life expectancy. Among men, 56.8% reported prostate specific antigen screening in the past two years, including 48.3% with <10-year life expectancy. Reported receipt of immunizations varied from 72.0% for influenza, 68.8% for pneumococcus, 57.7% for tetanus, and 42.6% for shingles vaccination. Lower life expectancy was associated with decreased likelihood of cancer screening and shingles vaccination but with increased likelihood of pneumococcal vaccination.

Conclusions

Despite the long time-to-benefit from cancer screening, in 2019 many US adults age >65 with <10-year life expectancy reported undergoing cancer screening while many did not receive immunizations with a shorter time-to-benefit. Interventions to improve individualization of preventive care based on older adults’ life expectancy may improve care of older adults.

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Funding

Dr. Schonberg’s time on this project was supported by a NIH/NIA K24 (AG071906). Dr. Schoenborn’s time on this project was supported by NIH/NIA K76 (AG059984).

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Author notes

  1. Lindsey Yourman and Jaclyn Bergstrom contributed equally to this work.

Authors and Affiliations

  1. Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California, San Diego, CA, USA

    Lindsey C. Yourman MD

  2. Medical Care Services, County of San Diego Health and Human Services Agency, San Diego, CA, USA

    Lindsey C. Yourman MD, Jaclyn Bergstrom MS & Alison A. Moore MD, MPH

  3. Division of Internal Medicine, Department of Medicine, University of Washington in St. Louis School of Medicine, St. Louis, MO, USA

    Elizabeth A. Bryant MD, MPH

  4. Stanford University, Palo Alto, CA, USA

    Alina Pollner

  5. Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Nancy Li Schoenborn MD, MHS

  6. Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Mara A. Schonberg MD, MPH

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Contributions

Lindsey Yourman, MD: contributed to the conception of the work, drafting and revising, approval of the final version, and is accountable for the study integrity. Jaclyn (Nikki) Bergstrom, M.S.: contributed to the design of the work, data analysis and interpretation, drafting of the work, approval of the final version, and is accountable for the study integrity. Elizabeth A. Bryant, MD, MPH: contributed to the interpretation of the data, draft, approval of the final version, and is accountable for the study integrity. Alina Pollner: contributed to the data analysis and interpretation, draft of the work, approval of the final version, and is accountable for the study integrity. Alison A. Moore MD, MPH: contributed to the design of the work, interpretation of data, critical revisions for important content, approval of the final version, and is accountable for the study integrity. Nancy Li Schoenborn, MD, MHS: contributed to the conception of the work, interpretation of data, critical revisions for important content, approval of the final version, and is accountable for the study integrity. Mara A. Schonberg, MD, MPH: contributed to the conception and design of the work, acquisition, and interpretation of data, drafting and revising, approval of the final version, and is accountable for the study integrity. All authors have access to the publicly available National Health Interview Survey upon which our study is based.

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Correspondence to Lindsey C. Yourman MD.

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Yourman, L.C., Bergstrom, J., Bryant, E.A. et al. Variation in Receipt of Cancer Screening and Immunizations by 10-year Life Expectancy among U.S. Adults aged 65 or Older in 2019. J GEN INTERN MED 39, 440–449 (2024). https://doi.org/10.1007/s11606-023-08439-2

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