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Surveillance for Use of Preventive Health-Care Services by Older Adults, 1995-1997

Gail R. Janes, Ph.D., M.S.1
Donald K. Blackman, Ph.D.2
Julie C. Bolen, Ph.D, M.P.H.1
Laurie A. Kamimoto, M.D., M.P.H.1,3
Luann Rhodes, M.P.A., M.P.H.1
Lee S. Caplan, M.D, M.P.H., Ph.D.2
Marion R. Nadel, Ph.D., M.P.H.2
Scott L. Tomar, D.M.D., Dr.P.H.4
James F. Lando, M.D., M.P.H.5
Stacie M. Greby, D.V.M., M.P.H.6
James A. Singleton, M.S.6
Raymond A. Strikas, M.D.6
Karen G. Wooten, M.A.7

1Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion
2Division of Cancer Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion
3Epidemic Intelligence Service, Epidemiology Program Office
4Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion
5Division of Applied Public Health Training, Epidemiology Program Office
6Division of Epidemiology and Surveillance, National Immunization Program
7Division of Data Management, National Immunization Program

Abstract

Problem/Condition: In 1995, a total of 55 million persons aged greater than or equal to 55 years lived in the United States. The members of this large and growing segment of the population are major consumers of health care. Their access to medical and dental preventive services contributes to their likelihood of healthy later years and influences their long-term impact on the health-care delivery system.

Reporting Period: 1995-1997.

Description of Systems: This report summarizes data from the National Health Interview Survey (NHIS), the state-based Behavioral Risk Factor Surveillance System (BRFSS), and the Medicare Current Beneficiary Study (MCBS) to describe national, regional, and state-specific patterns of access to and use of preventive services among persons aged greater than or equal to 55 years.

Results: During 1995-1997, approximately 90% of persons aged greater than or equal to 55 years living in the United States reported having a regular source of health-care services. However, only 75%-80% reported receiving a routine checkup during the preceding 2 years. The estimated percentage of persons who reported not being able to receive medical care because of cost was highest for those aged 55-64 years. Within this age group, the percentage was highest among Hispanics (4%) and persons without a high school diploma. Approximately 11% of Medicare beneficiaries reported delaying care because of cost or because they had no particular source of care. Percentage estimates varied according to age, race/ethnicity, and sociodemographic status. Approximately 95% of persons aged greater than or equal to 55 years reported having their blood pressure checked during the preceding 2 years, but only 85%-88% had received a cholesterol evaluation during the preceding 5 years. The percentage of women receiving breast and cervical cancer screening decreased with increasing age, and the percentage of persons aged greater than or equal to 55 years who had received some form of screening for colorectal cancer was low -- approximately 25% for fecal occult blood testing (FOBT) and 45% for endoscopy. State-specific rates of compliance with vaccination recommendations among persons aged greater than or equal to 65 years were higher for influenza vaccine (range: 54%-74%) than for pneumococcal vaccine (range: 32%-59%), and compliance increased with advancing age. State-specific estimates of the percentage of annual dental visits varied 40%-75%, and 41%-88% of persons aged greater than or equal to 65 years reported not having dental insurance.

Interpretation: Access to medical services among adults living in the United States is greater for persons aged greater than or equal to 65 years, compared with those aged less than 65 years, presumably because of Medicare coverage. In contrast, use of dental services decreased, despite increased need for preventive and restorative dental care. Although Medicare covers many medical services for older adults, financial, personal, and physical barriers to both medical and dental care create racial, regional, and sociodemographic disparities in health status and use of health services in the United States.

Public Health Action: Continued surveillance of access to and use of health services among older adults (i.e., persons aged greater than or equal to 65 years), as well as among persons aged 55-64 years, will help health-care providers target underserved groups, make Medicare coverage decisions, and develop public health programs to ensure equitable access to services and improve the health of older adults.

INTRODUCTION

Life expectancy has increased substantially during this century, and persons living in the United States who reach age 65 years have a high probability of living to age 80 years. Numerous health problems often accompany the last decades of life. However, adequate access to medical and dental care, including preventive services, can reduce premature morbidity and mortality, as well as preserve function and enhance overall quality of life (1-3). This report examines determinants of access to and use of health-care services among persons aged greater than or equal to 55 years living in the United States.

The Institute of Medicine (IOM) defines appropriate health-care access as "the timely use of personal health services to achieve the best possible health outcomes" (4). Access is influenced by many factors, including facilitators of and barriers to care. Having a regular source of care -- defined as a doctor or other health-care provider, or a specific site where care is provided -- is one of the strongest determinants of access to health care, independent of a person's age (5), potentially influencing both the likelihood of receiving care and the quality of that care.

IOM describes several types of barriers that can block access to health care, including financial and structural (i.e., physical) barriers. Lack of insurance is often a major financial barrier for persons aged less than 65 years. For persons aged greater than or equal to 65 years, access to care improves when they become eligible for Medicare, which now covers many clinical preventive services (6). However, out-of-pocket health-care costs for Medicare beneficiaries lacking supplemental insurance can still pose a major barrier, causing some beneficiaries to delay or avoid services viewed as discretionary (e.g., filling prescriptions) (7). Medicare beneficiaries who opt to join a Medicare managed-care plan can avoid some of these expenses and also receive coverage for some preventive services not covered by traditional Medicare. However, at the end of each calendar year, managed-care plan administrators can renegotiate their charges and covered benefits or leave the Medicare program. Difficulties getting to a health-care provider or long waiting times for an appointment can be major structural obstacles for older adults. This report presents age-specific national and state estimates of the percentage of these factors, based on the 1995 National Health Interview Study (NHIS), the 1995-1997 Behavioral Risk Factor Surveillance System (BRFSS), and the 1996 Medicare Current Beneficiary Survey (MCBS).

Screening

Timely and appropriate access to preventive services is important with increasing age. The Guide to Clinical Preventive Services of the U.S. Preventive Services Task Force (USPSTF) recommends screening older adults for treatable chronic conditions that are the major causes of death for this population (e.g., cardiovascular disease and cancer) (8). Screening for hypertension is recommended for both children and adults. Healthy People 2000 recommends increasing to greater than or equal to 90% the proportion of adults who have had their blood pressure measured during the preceding 2 years and who can state whether their blood pressure was normal or high (objective 15.13) (1). Hypertension is most prevalent among older adults and is a leading risk factor for both heart disease and cerebrovascular disease. Data from multiple trials suggest that antihypertensive treatment of persons aged greater than or equal to 60 years reduces mortality from all causes and reduces morbidity and mortality from stroke and coronary heart disease (CHD) (9).

Elevated serum cholesterol is also a major risk factor for CHD among men and women, but USPSTF deemed the epidemiologic evidence linking cholesterol and all-cause mortality among persons aged greater than 65 years insufficient to indicate the need for cholesterol screening for all persons in this age group (8). Thus, USPSTF recommends screening only for persons aged greater than 65 years with CHD risk factors. No direct evidence indicates that lowering cholesterol levels is beneficial for this population, but clinical trials are under way. Evidence indicates that cholesterol levels in older adults can be lowered by behavioral and pharmacologic interventions (8). The National Cholesterol Education Program Adult Treatment Panel II (NCEP II) revisited its guidelines in 1994 and now recommends routine measurement of nonfasting total cholesterol and high-density lipoprotein cholesterol (HDL-C) in all adults aged greater than or equal to 20 years at least once every 5 years (10). A Healthy People 2000 objective is to increase to greater than or equal to 75% the proportion of adults who have had their blood cholesterol checked during the preceding 5 years (objective 15.14) (1). Age-specific state estimates of the percentage of screening for hypertension and elevated serum cholesterol were calculated from the 1997 BRFSS for this report.

Morbidity and mortality associated with many types of cancers also increase with age. The significance of cancer prevention efforts have increased in recent years. For many cancers, risk factors are not amenable to change, so secondary prevention through screening and early detection is the main form of intervention. This report examines three cancers for which effective screening has been demonstrated to reduce mortality -- breast, cervical, and colorectal cancers.

In 1999, breast cancer will be diagnosed in an estimated 175,000 women, and 43,300 will die from the disease (11). An estimated 12,800 women will be diagnosed with invasive cervical cancer, and 4,800 will die (11). Approximately 129,400 persons will be diagnosed with colorectal cancer, and 56,600 will die from the disease (11). Early detection and timely treatment of these diseases can alter their progression and reduce mortality. USPSTF recommends regular breast cancer screening for women aged 50-69 years, although many groups recommend initiating screening at age 40 years. Breast cancer screening guidelines do not extend to women aged greater than or equal to 70 years because of the lack of clinical data on the effectiveness of screening this population. The American College of Physicians (ACP) recommends mammograms every 2 years for women aged 50-74 years. Healthy People 2000 set a national objective of increasing to greater than or equal to 60% the proportion of women aged greater than or equal to 50 years who have received a clinical breast examination and a mammogram during the preceding 1-2 years (objective 16.11) (1). USPSTF recommends routine cervical cancer screening with Papanicolaou (Pap) testing for all women who are sexually active and have a cervix. There is insufficent clinical data to support recommending Pap tests for women aged greater than 65 years whose previous screenings have been negative (8). This is supported by the Healthy People 2000 objective to increase to greater than or equal to 95% the proportion of women aged greater than or equal to 18 years with a cervix who have ever received a Pap test and to greater than or equal to 85% those who have received a Pap test during the preceding 1-3 years (objective 16.12) (1).

To reduce mortality from colorectal cancer, one or more of the following tests are recommended for persons aged greater than or equal to 50 years: a) annual fecal occult blood testing (FOBT), b) flexible sigmoidoscopy, or c) double-contrast barium enema (8,12,13). A Healthy People 2000 objective recommends increasing to greater than or equal to 50% the proportion of persons aged greater than or equal to 50 years who have received FOBT during the preceding 1-2 years and to greater than or equal to 40% those who have ever received proctosigmoidoscopy (objective 16.13) (1). This report presents 1997 state-specific BRFSS data on self-reported breast and cervical cancer screening among women aged greater than or equal to 55 years and colorectal cancer screening among men and women aged greater than or equal to 55 years.

As noted, Medicare covers several clinical preventive services, including influenza and pneumococcal vaccination, mammography, pap tests and pelvic exams, and colorectal cancer screening (including screening FOBT, flexible sigmoidoscopy, and colonoscopy). However, Medicare coverage for most preventive services was increased or initiated on January 1, 1998, by the Medicare provisions of the Balanced Budget Act of 1997. The data in this report were collected during 1997 (except 1995 NHIS data and 1995-1997 dental services data). In 1997, Medicare covered biennial screening mammography for women aged greater than or equal to 65 years and screening pap tests every 3 years, subject to the deductible for Medicare Part B (which covers physician services); influenza and pneumoccal vaccinations were covered with no deductible. Screening for colorectal cancer and elevated serum cholesterol were not covered benefits in 1997.

Vaccination

Appropriate and timely vaccination can substantially reduce the impact of vaccine-preventable infectious disease. In 1997, a total of 90% of U.S. deaths attributed to pneumonia and influenza occurred among persons aged greater than or equal to 65 years, making these illnesses the fifth leading cause of death for this age group (14). During influenza epidemics, persons aged greater than or equal to 65 years face increased risk for influenza-associated hospitalizations (range: from 200 to greater than 1,000/100,000 population during epidemics from 1972 through 1981) and deaths (range: from 25 to greater than 150/100,000 during 19 epidemics from 1972 through 1995) (15). Persons aged greater than or equal to 65 years are also at increased risk for invasive pneumococcal disease, including bacteremia and meningitis, with an estimated annual incidence of 50-83 cases/100,000 population compared with 15-30 cases/100,000 among persons of all ages (16).

To decrease morbidity and mortality from influenza and pneumococcal disease, annual influenza vaccinations and one dose of pneumococcal polysaccharide vaccine are recommended for persons aged greater than or equal to 65 years (8,15,16). Medicare has reimbursed one lifetime pneumococcal vaccination, including the cost of the vaccine since 1981 and the cost of administration since 1992. Since May 1, 1993, Medicare has reimbursed health-care providers for the cost of influenza vaccine and its administration. Both pneumococcal and influenza vaccination are covered under Medicare Part B, with no deductible. A Healthy People 2000 objective is to increase influenza and pneumococcal vaccination levels to greater than or equal to 60% among persons at high risk for complications, including those aged greater than or equal to 65 years (objective 20.11) (1). This report analyzes influenza and pneumococcal vaccination rates from the 1997 BRFSS by age and state.

Dental Services

Regular dental care is also important for older adults, who are at higher risk for numerous oral conditions and diseases because of age-related physiologic changes, use of various medications, and underlying chronic diseases (17). Oral diseases and conditions can impact quality of life among older adults (18-20). Regular dental visits allow dental health professionals to provide preventive services, early diagnosis, and treatment. Although limited empirical evidence supports the universal need for annual dental examinations, and because the appropriate frequency of dental visits is usually left to clinicians' judgment (8), older adults who do not receive regular care can be at increased risk for serious oral diseases. Thus, annual oral examinations are recommended for all adults, including those aged greater than or equal to 55 years (21). The American Cancer Society (ACS) recommends annual oral examinations for persons aged greater than or equal to 40 years (22), and USPSTF recommends regular dental visits for persons aged greater than or equal to 65 years (8).

Recognizing the importance of periodic dental visits, Healthy People 2000 established a national objective of increasing to approximately 70% the proportion of persons aged greater than or equal to 35 years who receive oral health care each year (objective 13.14) (1). Target levels for population subgroups with historically low rates of dental service use are slightly lower -- 50% for edentate persons (i.e., those with no natural teeth) and 60% for persons aged greater than or equal to 65 years.

Dental insurance coverage is a strong correlate of dental care use, particularly among older adults (23). Because dental insurance typically is provided as an employee benefit, retired persons are less likely to have dental insurance. With few exceptions, Medicare does not cover dental care services (24), and few states provide adult dental coverage under their Medicaid programs (25). This report analyzes the percentage of persons aged greater than or equal to 55 years who reported a dental visit and dental insurance coverage during the 12 months preceding participation in the 1995-1997 BRFSS, by age and state.

METHODS

All tables in this report were created using data from the 1995 NHIS, the 1995-1997 BRFSS, or the 1996 MCBS. All three data systems rely on self-reports, which can over- or underestimate the percentage of certain behaviors. The NHIS is an ongoing, annual, cross-sectional household survey of the U.S. resident civilian, noninstitutionalized population. NHIS data are obtained through personal interviews with household members. Information on all members of the household is collected, and proxy responses are allowed. The 1995 NHIS consisted of two parts: a set of basic health and demographic items and questions concerning current health topics. The 1995 sample design included the oversampling of both black and Hispanic persons to improve the stability of estimates for these groups (26). For this report, percentage estimates were stratified by age (55-64 years, 65-74 years, and greater than or equal to 75 years), race/ethnicity,* sex, education (less than 12 years of school, 12 years, or greater than 12 years), and region.**

SAS software (i.e., an integrated system for data access, management, analysis, and presentation) was used to calculate percentage estimates. Software for Survey Data Analysis (SUDAAN) (Version 7.0; Research Triangle Institute, Research Triangle Park, North Carolina) was used to calculate 95% confidence intervals (CIs).

The BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of U.S. resident civilian, noninstitutionalized persons aged greater than or equal to 18 years. This survey collects self-reported information regarding behaviors related to health status (27). The BRFSS excludes households without telephones, but only approximately 2.5% of older adults do not have a phone. Institutionalized persons, who are also excluded, likely account for approximately 5% of persons aged greater than or equal to 65 years (28). In 1997, a total of 25,000 persons aged greater than or equal to 65 years from 52 reporting areas (i.e., the 50 states, the District of Columbia, and Puerto Rico) participated in the BRFSS. Data from Puerto Rico were not included in these analyses. An Oral Health Module was added in 1995, and 46 states administered this module at least once during 1995-1997.

For this report, BRFSS data were aggregated to create a yearly sample for each state and stratified by age group (55-64 years, 65-74 years, greater than or equal to 65 years, and greater than or equal to 75 years). Missing data or data coded as "don't know" or "refused" were excluded from analyses. The data were then weighted to both the respondent's probability of selection and the distribution of each state's population by age, sex, and race/ethnicity, according to current census or intercensal estimates (29,30). SUDAAN statistical software was used to calculate state-specific percentages and 95% CIs. Median percentage estimates were based on combined state-specific percentage estimates from the 50 states and the District of Columbia. To increase the precision of estimates from the BRFSS Oral Health Module, data from multiple years (1995-1997) were merged for states that had administered the module at least once during this period.

The MCBS is a continuous, multipurpose, complex survey of noninstitutionalized and institutionalized Medicare beneficiaries, including disabled persons. It is designed to determine expenditures and sources of payment for all services used by Medicare beneficiaries, as well as the beneficiaries' health status and functioning, income, assets, living arrangements, family support, and access to medical care. For this report, MCBS data were summarized from the 1996 Access to Care File, a public-use data set of annual use and expenditure summaries from Medicare files, along with survey data about insurance coverage, health status and functioning, access to care, information needs, satisfaction with care, and income (31). The sampling frame comes from Medicare enrollment files of the Health Care Financing Administration (HCFA), with oversampling of disabled persons aged less than 65 years and all persons aged greater than or equal to 85 years. A new sample is added each year to include new Medicare beneficiaries and to replenish sample groups depleted by refusals and death. Personal interviews are conducted with beneficiaries or their proxies three times a year where the respondents reside. Sample members are followed for 4 years. This report analyzes only noninstitutionalized respondents aged greater than or equal to 65 years.

Two MCBS questions were designed to assess respondents' access to health care: "Have you had any trouble getting health care that you wanted or needed?" and "Were any medicines prescribed for you that you did not get [during the current year]?" Respondents who answered yes to the first question were classified as having trouble getting health care. Those who answered yes to the second question were classified as not getting prescribed medications. The following queries examined potential barriers to receipt of health care:

  • "Have you delayed seeking medical care because you were worried about the cost?" Respondents answering yes were classified as having delayed care because of cost.
  • "Please indicate how satisfied you have been with the ease and convenience in getting to a doctor from where you live." Respondents who indicated that they were either dissatisfied or very dissatisfied were classified as not satisfied with how easily they could get to a doctor.
  • "Is there a particular medical person or clinic you usually go to when you are sick or for advice about your health?" Respondents who answered no were classified as having no particular source of health care.
  • "Is there a particular doctor you usually see at this place?" Respondents who answered yes to the previous question were asked this follow-up question. Those who answered no to this question were classified as having no particular doctor at their usual health-care site.

SUDAAN statistical software was used to calculate percentage estimates and standard errors, adjusting for the complex structure of the survey. The estimates were stratified by combinations of race (black or white) and sex, by age groups (65-74 years, 75-84 years, and greater than or equal to 85 years), and by income levels (greater than $25,000, less than or equal to $25,000, less than or equal to $15,000, and less than or equal to $10,000), which are cumulative rather than mutually exclusive. The estimates were age-adjusted within the race/sex strata, sex-adjusted within the age strata, and age- and sex-adjusted within the income strata to the 1970 U.S. standard population.

RESULTS

Access to and Use of Health-Care Services

Most adults aged greater than or equal to 55 years reported having a regular source of medical care during the preceding year (Table 1). However, when the responses were stratified by age, persons aged less than 65 years were consistently less likely to have a regular source of care than persons aged greater than or equal to 65 years. The proportion of respondents who had a regular source of care also increased with education level. Hispanics aged less than 65 years were less likely to have a regular source of care, but data from respondents aged greater than or equal to 65 years demonstrated no consistent differences across racial and ethnic groups. Men were slightly but consistently less likely to report a regular source of care than women.

Persons with a regular source of medical care are more likely to receive basic medical services (e.g., a routine checkup), which presents the opportunity for delivery of preventive services (5). Most persons aged greater than or equal to 55 years reported having a routine checkup during the preceding 2 years, and use of this preventive service increased with increasing age (Table 2). The median value was 77.3% for persons aged 55-64 years, 84.6% for persons aged 65-74 years, and 87.8% for those aged greater than or equal to 75 years. The median of all responses was 86.1%. Across all age groups, the lowest percentage was among persons aged 55-64 years in California (66.2%), and the highest was among persons aged greater than or equal to 75 years in Louisiana (94.7%).

The NHIS asked respondents whether they had delayed seeking medical care during the preceding 12 months because of concern regarding the cost. In general, few respondents said yes (Table 3). Among persons aged less than 65 years, greater than or equal to 10% of Hispanics,*** non-Hispanic blacks, and persons with less than a high school education indicated that they had delayed care because of cost during the preceding year. The rate decreased for respondents aged greater than or equal to 65 years; for those aged 65-74 years, the rate was greater than 5% for Hispanics and persons with less than a high school education. Persons aged greater than or equal to 75 years reported that they rarely encountered this problem. Respondents to the BRFSS were also asked whether they had failed to receive medical care during the preceding year because of cost (Table 4). The percentage of persons who reported that cost was not a barrier increased with advancing age: the median value was 92.3% for persons aged 55-64 years, 96.2% for persons aged 65-74 years, and 97.0% for those aged greater than or equal to 75 years. The highest percentage of respondents who reported that cost was not a barrier was among persons aged greater than or equal to 75 years in Nevada (99.8.%), and the lowest was among persons aged greater than or equal to 75 years in Arizona (71.3%).

The MCBS also includes data on noninstitutionalized Medicare beneficiaries aged greater than or equal to 65 years who reported difficulties in accessing medical care (Table 5). Fewer than 5% of MCBS respondents reported problems receiving care or prescribed medications. When stratified by sex and race, the percentage of persons who reported difficulties receiving care ranged from 2.1% (white males) to 4.1% (black females). The percentage of persons who did not receive prescribed medications ranged from 2% (white males) to 4.7% (black females). When stratified by income, the proportion of persons who reported difficulties receiving care ranged from 2% for those in the highest income group (greater than $25,000) to 4% for those with incomes less than or equal to $10,000. In the high-income category, 1.7% did not receive prescribed medications, compared with 3.3% in the low-income group. Overall, respondents were more likely to report specific barriers to care (e.g., lack of ease getting to the doctor, cost, or no specific source of care). Among sex and race groups, 8.3% of black females reported dissatisfaction with the ease of getting to the doctor, compared with 3.7% of black males. Of the three age groups (i.e., 65-74 years, 75-84 years, and greater than or equal to 85 years), persons aged greater than or equal to 85 years were the most likely to report difficulties getting to the doctor (6.8%) as were those in the lowest income group (7.3%).

Despite the minimal percentage of respondents who reported difficulties receiving care or who did not fill prescriptions, a larger percentage reported delaying care because of cost, although percentages varied across groups. Approximately twice as many black males reported delaying care because of cost than did white males (9.3% versus 4.7%), and the same was true when black females were compared with white females (11.1% versus 6.5%). Persons aged 65-74 years were approximately twice as likely as persons aged greater than or equal to 85 years to have delayed care (6.8% versus 3.7%), and those in the lowest income stratum were approximately five times as likely as those in the highest income stratum to report delaying care (11.2% versus 2.3%). Black males and females also were more likely than white males and females to report not having a regular source of medical care (11.1% and 8.7% versus 7.4% and 6.0%). Persons with incomes less than or equal to $10,000 were approximately twice as likely as persons earning greater than $25,000 to have no regular source of care (11.0% versus 5.2%). Respondents who reported having a regular site of care were asked whether they saw a particular doctor at that site; 23.6% of black males and 15.6% of black females reported that they did not, compared with 11.3% of white males and 8% of white females. A higher percentage of persons aged 65-74 years reported not seeing a particular doctor (11.6%), compared with persons aged greater than or equal to 85 years (7.7%). Of persons earning greater than $25,000, a total of 7.5% reported having no regular doctor, compared with 18.9% of those with an income less than or equal to $10,000.

Screening

Data from the BRFSS were used to analyze how many adults aged greater than or equal to 55 years received blood pressure checks during the preceding 2 years. The median estimates were 95.1% among persons aged 55-64 years, 96.7% among persons aged 65-74 years, and 97.7% among persons aged greater than or equal to 75 years (Table 6). Values ranged from 89% for persons aged 55-64 years in Wisconsin to 100% for persons aged greater than or equal to 75 years in Georgia and the District of Columbia. The median estimates of the percentage of blood cholesterol checks during the preceding 5 years (Table 7) ranged from 84.9% among persons aged 55-64 years to 88.3% among persons aged 65-74 years. Values ranged from 68.3% among persons aged greater than or equal to 75 years in Kansas to 94.9% among persons aged 55-64 years in Michigan.

For breast cancer screening, the median percentages of women who reported having a mammogram during the preceding 2 years were 77.0% among those aged 55-64 years, 75.4% among those aged 65-74 years, and 61.4% among those aged greater than or equal to 75 years (Table 8). State-specific percentages ranged from 57.3% (Arkansas) to 90.7% (Alaska) among women aged 55-64 years; from 55.7% (Arkansas) to 87.4% (Rhode Island) among women aged 65-74 years; and from 37.9% (Indiana) to 75.3% (District of Columbia) among women aged greater than or equal to 75 years. For most states, the lowest percentage was among women aged greater than or equal to 75 years.

The BRFSS also collects data on eligible women (i.e., those with an intact uterus) who reported having a Pap test during the preceding 3 years (Table 9). The median percentages were 83.4% among women aged 55-64 years, 77.4% among women aged 65-74 years, and 58.2% among women aged greater than or equal to 75 years. State-specific percentages ranged from 66.8% (Arizona) to 92% (District of Columbia) among women aged 55-64 years; from 65.7% (Nevada) to 89.1% (South Carolina) among women aged 65-74 years; and from 40.7% (Mississippi) to 81.8% (District of Columbia) among women aged greater than or equal to 75 years. For all states except Arizona, the lowest percentage was among women aged greater than or equal to 75 years.

The median percentages of persons who reported having FOBT during the preceding 2 years were 25.8% among persons aged 55-64 years, 31.7% among persons aged 65-74 years, and 27.2% among persons aged greater than or equal to 75 years (Table 10). The percentages ranged from 12.9% (Mississippi) to 40.0% (North Carolina) among persons aged 55-64 years; from 13.6% (Oklahoma) to 46.8% (Oregon) among persons aged 65-74 years; and from 13.9% (Oklahoma) to 43.0% (Maine) among persons aged greater than or equal to 75 years. When the values were stratified according to sex and age, more women reported having FOBT than did men in both age groups (55-64 years and greater than or equal to 65 years). Among both men and women, the median percentages were higher among persons aged greater than or equal to 65 years than among those aged 55-64 years.

The median percentages of persons who reported ever having sigmoidoscopy or proctoscopy were 40.3% among persons aged 55-64 years, 48.3% among persons aged 65-74 years, and 46.3% among persons aged greater than or equal to 75 years (Table 11). State-specific percentages ranged from 26.8% (Oklahoma) to 54.0% (Minnesota) among persons aged 55-64 years; from 17.4% (Oklahoma) to 61.9% (Wisconsin) among persons aged 65-74 years; and from 30.6% (Oklahoma) to 63.5% (Virginia) among persons aged greater than or equal to 75 years. Among men, the median percentages were 44.3% among those aged 55-64 years and 53.3% among those aged greater than or equal to 65 years. Among women, the corresponding median values were 37.2% and 43.3%. Median percentages were consistently higher among men, as well as among men and women aged greater than or equal to 65 years.

Vaccination

In 1997, the percentage of persons aged 55-64 years who reported receiving influenza vaccination during the preceding 12 months ranged from 28.5% in Georgia to 54.7% in Colorado (median: 38.2%) (Table 12). Among persons aged 65-74 years, percentages ranged from 48.7% in Nevada to 72.4% in Colorado (median: 63.6%). Among persons aged greater than or equal to 75 years, percentages ranged from 51.7% in the District of Columbia to 82.0% in Arizona (median: 71.4%).

The percentage of persons aged 55-64 years who reported in 1997 that they had ever received a pneumococcal vaccination ranged from 9.5% in New York to 30.7% in Alaska (median: 17.1%) (Table 13). Among persons aged 65-74 years, percentages ranged from 30.1% in New Jersey to 56.9% in Arizona (median: 42.6%). Among persons aged greater than or equal to 75 years, percentages ranged from 31.4% in Louisiana to 79.0% in Nevada (median: 53.3%).

Dental Services

According to the BRFSS data, the percentage of persons aged greater than or equal to 65 years who had visited a dentist during the preceding 12 months ranged from 39.7% in Oklahoma to 75.4% in Hawaii (median: 59.1%) (Table 14). Overall, use of dental services decreased with advancing age, from a median of 67.5% among persons aged 55-64 years to 63.0% among persons aged 65-74 years and to 56.1% among persons aged greater than or equal to 75 years. Of the 46 states with data on adult dental visits, 22 (48%) reported that<F128M> "60% of persons aged greater than or equal to 65 years had obtained dental services during the preceding 12 months, which is the Healthy People 2000 objective (objective 13.14). In seven states (15%), fewer than 50% of persons aged greater than or equal to 65 years visited a dentist during the preceding 12 months. Five of these states were located in the South. In 15 states (33%), fewer than 50% of persons aged greater than or equal to 75 years visited a dentist during the preceding 12 months.

Lack of dental insurance coverage was more common among persons aged greater than or equal to 65 years (median: 73.8%) than among those aged 55-64 years (median: 48.1%) (Table 15). In every state except Hawaii, greater than 50% of persons aged greater than or equal to 65 years reported not having dental insurance. In all 46 states included in this analysis, most persons aged greater than or equal to 75 years reported not having dental insurance coverage (median: 79.8%). In 31 states (67%), greater than or equal to 75% of persons in this age group reported not having dental care coverage.

DISCUSSION

Access to and Use of Health-Care Services

Ensuring access to the full range of medical and dental services is critical to both the duration and quality of life for older adults living in the United States. This report examines barriers to health care (e.g., cost and the lack of a regular source of care). Overall, cost is not a major barrier to care for most older adults, although certain factors (e.g., race/ethnicity, educational attainment, and income) can increase a person's chances of deferring care because of cost. Although out-of-pocket expenses (i.e., copayments and deductibles) can be a burden for some Medicare beneficiaries who cannot afford supplemental or Medi-gap insurance (7), MCBS data indicate that few Medicare beneficiaries have problems receiving care or prescribed medications for any reason. A slightly higher percentage of persons reported not being satisfied with the ease of getting to a doctor, which might reflect age-related transportation difficulties (e.g., persons who no longer drive and are dependent on friends and relatives or on public transportation).

Most persons aged greater than or equal to 55 years also reported having a regular source of care. Research has demonstrated that persons with any type of regular source of health care have better access to care than those without a regular source, as measured by a set of preventive and primary-care use indicators (5). Because persons with a regular source of care are more likely to access primary-care services, the rates of persons receiving routine checkups and the rates of persons who have a regular source of care should be similar. However, state- and age-specific estimates of the percentage of persons aged greater than or equal to 55 years reporting a routine check-up during the preceding 2 years is lower than the national estimates of persons with a regular source of care. One reason could be that respondents who receive care of some chronic condition(s) might have underreported this factor, although they receive regular preventive care as part of their routine visits.

Screening

Numerous health reports have emphasized the importance of primary, secondary, and tertiary screening of older adults to prevent, delay, or minimize disease, risk factors, preexisting conditions, and disability and to enhance both health status and quality of life (2,32). Thus, USPSTF and other organizations (e.g., ACP and ACS) have published age-specific guidelines for delivery of preventive services to persons aged greater than or equal to 65 years (8). Screening for cardiovascular disease (CVD) and its risk factors is particularly important among older adults. The percentage of hypertension, an important risk factor for CVD, increases with age, and treatment has been demonstrated to be effective for all adults, including persons aged greater than or equal to 55 years (2). Regular screening for hypertension is recommended for all adults aged greater than or equal to 21 years (8). The relation between cholesterol and CVD is supported by clinical and epidemiologic studies (33), and regular screening is recommended for persons who are middle-aged or at high risk for disease (8,10). Although the relation between lipid-lowering therapies and morbidity and mortality among older adults is less conclusive than for younger adults, evidence indicates that cholesterol reduction could be effective for older adults (34). Both USPSTF and ACP suggest that individualized screening and treatment is appropriate for persons aged 65-75 years who are healthy but at high risk for disease (8,2,35). NCEP II recommends routine measurement of nonfasting total cholesterol and HDL-C levels in adults aged greater than or equal to 20 years every 5 years (10). Consistent with these recommendations, the state- and age-specific percentage estimates for blood pressure screening are high (median: greater than 95% for adults aged greater than or equal to 55 years). However, rates are lower for blood cholesterol checks, which vary from 85% to 90% for adults aged greater than or equal to 55 years.

In 1991, Healthy People 2000 set objectives for increasing the use and timeliness of cancer screening procedures (1). Several federal initiatives have been developed in recent years for breast and cervical cancer screening. Breast cancer is the most common malignancy among women and is second only to lung cancer as the leading cause of cancer deaths (11). In the United States, the incidence of breast cancer increased rapidly during 1973-1990 but remained stable during 1991-1995 (36). The death rate from breast cancer, which had been on the rise, has decreased 5.3% among white women but increased 0.6% among black women during 1991-1995 (36,37). Breast cancer screening has been demonstrated to reduce mortality in women aged 50-69 years (8,38,39). Most recommendations suggest screening women in this age group with a mammogram and a clinical breast examination every 1-2 years. Less consensus exists regarding continued screening among women aged greater than or equal to 70 years because of the lack of data on screening effectiveness for this age group. However, both breast cancer incidence and mortality increase substantially with advancing age (37,40). Despite this, the results reported in this publication indicate that breast cancer screening is less common among women aged greater than or equal to 65 years, compared with women aged 55-64 years.

During 1973-1995, the incidence of cervical cancer declined 43.3% overall and 52.0% among women aged greater than or equal to 65 years, whereas the mortality rate declined 45.9% overall and 50.0% among women aged greater than or equal to 65 years (37). Much of this reduction has been associated with increased use of Pap tests, although the effectiveness of this test for reducing cervical cancer mortality has only been evaluated in observational studies, not in randomized clinical trials (41). Pap tests can detect asymptomatic precancerous lesions (i.e., dysplasia), as well as preinvasive lesions that can progress to invasive cervical cancer if untreated (41). Detection and treatment of precancerous and preinvasive lesions can reduce the risk for developing invasive cervical cancer (42) and thereby improve the prognosis for women diagnosed with these conditions. An estimated 37%-60% reduction in cervical cancer mortality could be achieved with regular screening for all women (43). Thus, USPSTF, ACS, ACP, and other health organizations recommend Pap tests for all sexually active women aged less than or equal to 65 years who have a cervix. USPSTF states that testing can be discontinued after age 65 years if previous screenings have been negative. However, older women are more often diagnosed at later stages of disease and are more likely to die from the disease than younger women (1). They also are less likely than younger women to have ever received screening. Furthermore, the 5-year survival rate is 57.0% among women aged 65-74 years and 45.7% among women aged greater than or equal to 75 years, compared with 61.4% among women aged 55-64 years (11). For these reasons, older women could benefit from timely cervical cancer screening (11).

Comparing this report's findings on Pap tests with reports during 1988-1989 indicates that the proportion of women who reported ever receiving a Pap test and the proportion who reported receiving a test during the preceding 3 years have not changed substantially in the past decade (1,44,45). In this report, approximately 83% of women aged 55-64 years reported receiving a Pap test during the preceding 3 years, which suggests that more progress has been made toward achieving the Healthy People 2000 objective (objective 16.12) among this age group (95%) than among women aged greater than or equal to 75 years (median: 58%).

Colorectal cancer is the second leading cause of cancer-related death and the third most commonly diagnosed cancer for both men and women in the United States (11). The risk for developing colorectal cancer increases with advancing age, and the risk is higher among men than women (37,12). Overall, colorectal cancer incidence decreased 7.4% during 1973-1995. During the same period, incidence decreased 5.3% among males and 10.4% among females, 9.6% among persons aged less than 65 years, and 6.1% among persons aged greater than or equal to 65 years (37). However, the incidence among blacks of both sexes, especially males, has increased and exceeds the rate among whites. Although the colorectal cancer mortality rate decreased 20.8% among the general population during 1973-1995, mortality increased 26.1% among black males aged greater than or equal to 65 years and 15.6% among black males aged less than 65 years (37). Overall mortality is considerably higher among blacks than whites.

Recent research has demonstrated that screening to detect colorectal cancer early reduces mortality (13). Current technology also allows curative excision of early-stage colorectal cancers during the screening procedure. The 5-year survival rate for persons with localized disease is approximately 91%. However, only 37% of colorectal cancers are diagnosed at a localized stage. The 5-year survival rate is reduced to 34% for persons with regional-stage disease and to 8% for those with advanced-stage disease.

ACS recommends screening all persons aged greater than or equal to 50 years who are at average risk for disease, using one of the following methods: a) annual FOBT plus flexible sigmoidoscopy every 5 years, b) total colon exam by either colonoscopy every 10 years, or c) double-contrast barium enema every 5-10 years (12). ACS also recommends a digital rectal exam with sigmoidoscopy or colonoscopy. An interdisciplinary task force supported by five major gastroenterological professional societies has released similar guidelines (13). In 1996, USPSTF revised its clinical preventive services guidelines (8,12) following the results of a randomized clinical trial that demonstrated a 33% reduction in colorectal cancer mortality among persons advised to have annual FOBT, compared with controls. USPSTF now recommends annual FOBT beginning at age 50 years and recommends sigmoidoscopic screening but does not specify how often.

The 1997 BRFSS data demonstrate that screening rates for colorectal cancer among older adults are lower than those for breast and cervical cancers, a finding that is consistent with earlier reports (13,46,47). Trends for FOBT are difficult to estimate because the 1997 BRFSS question was changed to apply to home test kits only. Approximately 28% of persons aged greater than or equal to 55 years reported having FOBT using a home kit during the preceding 2 years, which is less than the Healthy People 2000 objective of 50% (objective 16.13). Approximately 40% of persons aged greater than or equal to 55 years reported ever having proctoscopy or sigmoidoscopy, which is consistent with the Healthy People 2000 objective (objective 16.13). However, the BRFSS questionnaire does not distinguish between tests conducted for diagnosis and those conducted for screening, resulting in a likely overestimate of the actual percentage of screening (47). This might explain why persons aged 65-74 years have the highest screening rates, followed by persons aged greater than or equal to 75 years.

These results reflect varying degrees of progress toward achieving national objectives for cancer screening. Data suggest major strides in increasing the proportion of women who receive timely breast and cervical cancer screening, although the numbers are still lower for older women, despite Medicare coverage for these services since 1991. Ongoing programs (e.g., CDC's National Breast and Cervical Cancer Early Detection Program) designed to promote screening, follow-up, and referral for medically underserved women should be broadened to include older women. Colorectal cancer screening has been slow to gain acceptance among both patients and health-care providers, and similar efforts might be required to support and encourage delivery and use of this clinical preventive service.

Vaccination

This report indicates that in 1997, influenza vaccination coverage exceeded the Healthy People 2000 objective of 60% (objective 20.11) in 38 states among persons aged 65-74 years and in all states except Alaska among persons aged greater than or equal to 75 years. Among persons aged greater than or equal to 65 years, only five states and the District of Columbia had coverage levels less than 60%.

Among persons aged 65-74 years and greater than or equal to 65 years, no state met or exceeded the Healthy People 2000 objective of 60% pneumococcal vaccination coverage (objective 20.11). Among persons aged greater than or equal to 75 years, pneumococcal vaccination coverage exceeded the 60% objective in nine states.

Persons aged greater than or equal to 75 years were more likely than persons aged 65-74 years to report receiving influenza and pneumococcal vaccinations or better health care that impacts survival. Increased age might represent increased opportunity for patient encounters with the health-care system, increased offers for vaccination by providers, and increased perception of need for vaccination by both patients and providers. Awareness of the need for routine vaccination should be increased among health-care providers and all persons aged greater than or equal to 65 years.

Low vaccination rates among persons aged 55-64 years could reflect the lack of routine vaccination recommendations for this population in 1997 and the lack of Medicare coverage, which does not begin until age 65 years. Among persons aged 55-64 years, influenza vaccination is particularly recommended for the following groups: a) residents of nursing homes or other chronic care facilities that house persons of any age with chronic medical conditions; b) persons with chronic disorders of the pulmonary or cardiovascular system; c) persons who required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, or hemoglobinopathies; d) persons with immunosuppression, including those infected with the human immunodeficiency virus (HIV); and e) persons who care for or live with persons at high risk for complications of influenza (15).

Pneumococcal vaccination is recommended for the following groups of persons aged 2-64 years: a) those with chronic cardiovascular disease, chronic pulmonary disease (i.e., chronic obstructive pulmonary disease and emphysema, but not asthma), diabetes mellitus, alcoholism, chronic liver disease, cerebrospinal fluid (CSF) leaks, or functional or anatomic asplenia; b) persons in certain environments or social settings (e.g., Alaskan Natives and some American Indian populations living on reservations with high disease incidence); and c) immunocompromised persons, including persons infected with HIV (16). Most subgroups recommended for influenza and pneumococcal vaccination could not be identified with BRFSS, and institutionalized populations are not included in BRFSS.

Vaccination rates varied substantially by state. Multiple factors are likely to account for state differences, including patterns of physician practice, existence of public health adult vaccination programs, and patients' attitudes and access to care. Public and private providers of adult immunization services at the state level need to be more aware of the factors known to affect vaccination services (e.g., a doctor's recommendation for vaccination, locations of vaccination services, and a patient's reasons for accepting or declining vaccination services). Increased awareness will aid the development and implementation of effective public health policies and practices to increase adult vaccination rates.

This study has at least two limitations. First, self-reports regarding vaccination were not validated. However, in previous studies, the sensitivity of self-report of influenza vaccination during the preceding influenza season ranged from 92% to 100% when vaccination status was validated by record review; specificity ranged from 71% to 98% (48,49). Using an interpretation of the kappa scale (50), the agreement between self-report and medical records ranged from substantial to almost perfect (kappa range: 0.74-0.92). The sensitivity of self-report of ever receiving pneumococcal vaccination ranged from 87% to 97% when vaccination status was validated by record review. Specificity ranged from 53% to 76%, and agreement with record review was moderate to substantial (kappa range: 0.42-0.64) (49,50). The second limitation of this study is that samples of persons in racial and ethnic minority groups were not large enough to accurately estimate vaccination coverage for these populations in most states. Analysis of the 1997 BRFSS aggregated data across states for persons aged greater than or equal to 65 years indicated lower levels of influenza and pneumococcal vaccination among non-Hispanic blacks and Hispanics compared with whites (51).

During 1995-1997, influenza and pneumococcal vaccination coverage among persons aged greater than or equal to 65 years increased in most states (51). However, use of both vaccines among persons aged 65-74 years and use of pneumococcal vaccine among all persons aged greater than or equal to 65 years must increase to reach the Healthy People 2000 objectives. An objective of greater than or equal to 90% coverage for influenza and pneumococcal vaccinations among persons aged greater than or equal to 65 years has been developed for the Healthy People 2010 objectives planned for release in January 2000 (52).

Since 1981, pneumococcal vaccinations have been covered for persons enrolled in Medicare Part B; influenza vaccinations have been covered since 1993 (6). Continued education of health-care providers and the community is needed to increase awareness of and demand for adult vaccination services. Interventions (e.g., standing orders for vaccination, provider reminders and feedback, and patient reminders) have been effective in increasing adult vaccination levels (53,54). Guidelines and tools for implementing these interventions are available through Put Prevention into Practice, a national campaign to improve delivery of clinical preventive services (55). In addition, opportunities for vaccination outside traditional health-care settings could be increased to reach older adults who do not routinely access traditional health-care settings.

Dental Services

Based on BRFSS data, fewer than one-half of states have achieved the Healthy People 2000 objective for increased use of dental care services among persons aged greater than or equal to 65 years (objective 13.14). This suggests a need for improvement in appropriate use of care. For example, edentate persons (i.e., those who have lost all of their natural teeth) are substantially less likely than dentate persons (i.e., those with natural teeth) to seek dental care (17). Older adults are more likely than younger adults to be edentate, and this factor could account for some differences in the use of dental services among age groups. A strong correlation exists between the proportion of older adults in a state who visited a dentist and the proportion of this population who are edendate (CDC, unpublished data, 1999). Because edentate persons are less likely to visit a dentist, their likelihood of early detection of oral pathology as part of a periodic dental exam is lower. However, tooth loss is not an inevitable characteristic of aging and probably reflects past dental treatment practices and societal attitudes toward tooth loss, as well as dental disease experience (56). Both life expectancy and the proportion of persons retaining their natural teeth into advanced age are increasing in the United States, and the need for preventive and restorative oral health services also will increase (57).

Ensuring oral health function and quality of life among older adults living in the United States will require sustained efforts to promote proven methods of preventing and controlling oral disease. These measures include community water fluoridation, clinical preventive services, and early detection and treatment of oral and dental conditions. To help ensure appropriate and equitable access to and use of oral health services among older adults, health-care delivery systems might need to be modified to include coverage for these services.

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* Race/ethnicity data are presented only for non-Hispanic whites, non-Hispanic blacks, and Hispanics because sample sizes for other racial/ethnic groups were too small for meaningful analysis.

** Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; and West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

*** Persons of Hispanic origin can be of any race.



Table 1

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TABLE 1. Percentage of adults aged >=55 years who reported having a regular source(s) of medical care during the preceding year, by selected sociodemographic characteristics -- United States, National Health Interview Survey, 1995*

 

Age group (yrs)

 

55-64

65-74

>=75

Characteristics

%

(95% CI)

%

(95% CI)

%

(95% CI)

Race/Ethnicity

           

White, non-Hispanic

92.4

(0.8)

95.1

(0.6)

95.7

(0.7)

Black, non-Hispanic

93.4

(1.9)

93.3

(2.1)

96.7

(2.1)

Hispanic**

85.9

(2.7)

93.7

(2.1)

96.1

(2.4)

Sex

           

Male

90.4

(1.0)

94.0

(0.9)

95.4

(1.1)

Female

93.4

(0.8)

95.5

(0.7)

96.1

(0.8)

Education (yrs)

           

<12

89.2

(1.6)

93.6

(1.1)

95.4

(0.9)

12

92.1

(1.0)

95.5

(0.9)

95.9

(1.1)

>12

93.7

(1.1)

95.2

(1.1)

96.8

(1.1)

Region††

           

Northeast

93.5

(1.4)

95.2

(1.2)

95.4

(1.7)

Midwest

92.1

(1.5)

94.6

(1.3)

95.9

(1.1)

South

91.4

(1.2)

94.8

(1.0)

96.1

(1.0)

West

91.0

(1.6)

94.6

(1.4)

95.9

(1.4)

Total

92.1

(0.7)

94.9

(0.6)

95.8

(0.7)

* n = 17,891.
† Source(s) of care are defined as a doctor or other health-care provider, or a specific site where medical care was provided. Persons citing multiple sources might or might not have visited one source more than another.
Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Race/ethnicity data are presented only for non-Hispanic whites, non-Hispanic blacks, and Hispanics because sample sizes for other racial/ethnic groups were too small for meaningful analysis.
** Persons of Hispanic origin can be of any race.
†† Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; and West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.


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Table 2

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TABLE 2. Percentage of adults aged >=55 years who reported having a routine checkup during the preceding 2 years, by state and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age group (yrs)

 

55-64

65-74

>=65

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

77.9

(5.4)

88.1

(4.2)

87.0

(3.6)

85.3

( 6.5)

Alaska

74.5

(9.7)

83.7

(9.1)

82.0

(8.2)

76.6

(18.2)

Arizona

83.3

(5.6)

88.3

(5.3)

87.9

(4.4)

87.2

( 7.2)

Arkansas

74.5

(6.2)

79.9

(5.9)

81.7

(4.2)

84.0

( 5.7)

California

66.2

(5.0)

76.3

(4.6)

78.1

(3.5)

80.7

( 5.2)

Colorado

72.6

(7.3)

81.1

(6.1)

81.1

(4.7)

81.1

( 7.1)

Connecticut

75.6

(8.4)

86.1

(4.6)

88.6

(3.3)

92.3

( 4.3)

Delaware

82.1

(4.6)

85.1

(4.0)

86.9

(3.1)

90.0

( 4.6)

District of Columbia

83.1

(6.1)

83.2

(7.5)

86.5

(5.2)

91.8

( 6.2)

Florida

79.2

(4.6)

90.6

(2.7)

91.8

(1.8)

93.3

( 2.4)

Georgia

72.9

(6.2)

91.0

(3.9)

90.5

(3.3)

89.7

( 5.3)

Hawaii

83.0

(5.6)

86.8

(5.0)

87.4

(3.9)

88.3

( 6.5)

Idaho

75.8

(4.9)

78.3

(4.0)

78.8

(3.0)

79.5

( 4.6)

Illinois

80.2

(4.9)

87.2

(4.3)

87.3

(3.2)

87.6

( 4.9)

Indiana

77.3

(5.3)

82.1

(5.3)

81.9

(4.3)

81.5

( 7.4)

Iowa

72.4

(5.0)

75.2

(4.6)

77.6

(3.2)

80.6

( 4.1)

Kansas

84.1

(5.0)

88.1

(4.5)

89.0

(3.3)

90.4

( 4.7)

Kentucky

74.3

(4.6)

85.7

(3.4)

86.9

(2.5)

88.8

( 3.4)

Louisiana

74.3

(7.0)

87.0

(5.3)

89.7

(3.7)

94.7

( 3.8)

Maine

77.3

(6.6)

86.4

(5.3)

89.0

(3.5)

92.6

( 4.8)

Maryland

83.3

(3.9)

89.8

(3.5)

91.2

(2.6)

93.8

( 3.1)

Massachusetts

90.0

(5.1)

90.0

(4.9)

89.8

(3.8)

89.5

( 6.0)

Michigan

81.8

(4.9)

86.8

(5.0)

85.9

(3.7)

84.6

( 5.7)

Minnesota

73.8

(4.2)

78.8

(4.0)

80.2

(2.9)

81.9

( 3.8)

Mississippi

80.0

(6.1)

84.4

(5.6)

86.3

(4.0)

89.5

( 5.4)

Missouri

70.9

(6.5)

88.3

(4.9)

90.0

(3.5)

92.7

( 4.2)

Montana

73.9

(6.3)

71.1

(6.8)

76.8

(4.8)

84.6

( 5.5)

Nebraska

76.5

(5.5)

73.5

(5.6)

77.6

(3.7)

82.6

( 4.6)

Nevada

79.3

(6.9)

78.3

(8.7)

79.6

(7.4)

82.8

(14.3)

New Hampshire

77.4

(7.3)

83.1

(6.1)

85.2

(4.3)

88.4

( 6.0)

New Jersey

81.9

(5.3)

89.2

(4.0)

89.4

(3.0)

89.8

( 4.4)

New Mexico

72.3

(6.8)

79.5

(5.7)

80.1

(4.3)

81.1

( 7.0)

New York

79.6

(4.7)

91.5

(3.1)

91.5

(2.4)

91.4

( 3.6)

North Carolina

81.4

(4.1)

84.7

(3.7)

85.4

(2.9)

86.8

( 4.3)

North Dakota

77.2

(6.5)

82.2

(5.5)

83.6

(3.8)

85.4

( 5.1)

Ohio

80.3

(5.3)

87.7

(3.9)

89.3

(2.7)

92.5

( 3.3)

Oklahoma

77.9

(6.0)

80.5

(4.0)

82.4

(3.2)

87.9

( 5.1)

Oregon

82.2

(4.0)

80.5

(4.5)

81.3

(3.3)

82.6

( 4.8)

Pennsylvania

80.6

(4.1)

89.8

(3.3)

90.5

(2.4)

91.7

( 3.5)

Rhode Island

86.2

(5.2)

90.2

(4.2)

91.4

(3.1)

93.3

( 4.4)

South Carolina

70.5

(6.0)

88.1

(4.0)

88.7

(3.0)

89.9

( 4.8)

South Dakota

72.6

(6.6)

83.7

(5.0)

84.0

(3.5)

84.3

( 4.9)

Tennessee

81.7

(4.5)

88.2

(3.9)

88.2

(2.9)

88.2

( 4.2)

Texas

78.6

(5.6)

85.6

(5.3)

85.8

(4.0)

86.2

( 5.8)

Utah

71.3

(6.9)

81.7

(6.2)

84.6

(4.2)

88.3

( 5.5)

Vermont

78.4

(4.6)

76.9

(5.0)

82.9

(3.4)

91.5

( 3.5)

Virginia

76.9

(6.0)

86.2

(4.7)

86.6

(3.5)

87.3

( 5.3)

Washington

71.7

(5.1)

79.5

(4.7)

78.2

(3.7)

76.4

( 6.0)

West Virginia

76.5

(5.1)

87.7

(3.9)

88.1

(3.0)

88.9

( 4.9)

Wisconsin

69.2

(6.7)

79.6

(6.5)

80.3

(4.8)

81.6

( 6.6)

Wyoming

70.2

(5.9)

73.7

(6.3)

74.4

(4.8)

75.5

( 7.1)

Median

77.3%

84.6%

86.1%

87.8%

Range

(66.2%-90.0%)

(71.1%-91.5%)

(74.4%-91.8%)

(75.5%-94.7%)

* n = 41,308.
† Respondents were asked, "About how long has it been since you last visited a doctor for a routine checkup?" Persons who reported having a routine checkup during the preceding 2 years are reported.
Confidence interval. CIs were calculated by multiplying the standard error by 1.96.


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Table 3

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TABLE 3. Percentage of adults aged >=55 years who reported delaying medical care during the preceding year because of cost, by selected sociodemographic characteristics -- United States, National Health Interview Survey, 1995*

 

Age group (yrs)

 

55-64

65-74

>=75

Characteristics

%

(95% CI)

%

(95% CI)

%

(95% CI)

Race/Ethnicity

           

White, non-Hispanic

7.5

(0.8)

3.6

(0.6)

2.4

(0.5)

Black, non-Hispanic

10.0

(2.2)

4.5

(1.6)

2.9

(1.8)***

Hispanic**

11.0

(2.4)

5.4

(1.9)

3.9

(2.3)

Sex

           

Male

6.5

(0.9)

3.2

(0.6)

1.8

(0.7)

Female

9.5

(1.0)

4.3

(0.7)

2.8

(0.6)

Education (yrs)

           

<12

13.2

(1.7)

5.1

(1.0)

3.4

(0.8)

12

7.7

(1.1)

3.3

(0.7)

1.9

(0.7)

>12

5.4

(0.9)

3.0

(0.8)

1.4

(0.8)

Region††

           

Northeast

6.3

(1.6)

2.7

(0.8)

1.9

(0.8)

Midwest

8.0

(1.4)

4.5

(1.3)

1.8

(0.7)

South

9.7

(1.2)

4.2

(0.8)

2.9

(0.9)

West

7.3

(1.4)

3.5

(1.0)

3.0

(1.3)

Total

8.1

(0.7)

3.8

(0.5)

2.4

(0.5)

* n = 19,980.
† Respondents were asked, "During the past 12 months, have you delayed medical care because of worry about the cost?" Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Race/ethnicity data are presented only for non-Hispanic whites, non-Hispanic blacks, and Hispanics because sample sizes for other racial/ethnic groups were too small for meaningful analysis.
** Persons of Hispanic origin can be of any race.
†† Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia; and West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming.
*** Estimate might be unstable (relative standard error 0.3) because of small sample size.


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Table 4

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TABLE 4. Percentage of adults aged >=55 years who reported that cost was not a barrier to obtaining medical care during the preceding year, by state and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

State

Age group (yrs)

55-64

65-74

>=65

>=75

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

89.4

(3.8)

94.0

(3.1)

95.2

(2.1)

97.0

( 2.3)

Alaska

91.7

(4.7)

94.2

(4.8)

94.4

(4.3)

94.9

(10.2)

Arizona

73.9

(8.4)

82.9

(5.1)

78.1

(4.5)

71.3

( 8.6)

Arkansas

82.6

(5.2)

88.8

(4.4)

87.9

(3.7)

86.8

( 6.3)

California

91.7

(2.8)

98.7

(1.4)

98.8

(0.9)

99.0

( 1.1)

Colorado

94.6

(3.4)

98.1

(1.9)

98.4

(1.5)

98.8

( 2.4)

Connecticut

95.9

(2.7)

98.7

(1.4)

98.1

(1.2)

97.2

( 2.3)

Delaware

91.7

(3.5)

96.8

(1.8)

97.1

(1.3)

97.8

( 1.6)

District of Columbia

87.8

(5.2)

93.3

(5.1)

94.3

(3.5)

95.8

( 3.8)

Florida

87.1

(4.0)

96.6

(1.6)

97.2

(1.1)

98.0

( 1.3)

Georgia

94.2

(2.9)

98.9

(1.1)

97.6

(1.6)

95.0

( 4.5)

Hawaii

94.6

(3.3)

97.2

(2.1)

97.1

(1.8)

97.0

( 3.4)

Idaho

93.1

(2.1)

96.4

(1.7)

96.6

(1.2)

97.0

( 1.6)

Illinois

94.0

(2.7)

95.3

(3.4)

96.0

(2.3)

97.2

( 2.3)

Indiana

93.4

(3.3)

98.1

(2.0)

97.8

(1.5)

97.3

( 2.4)

Iowa

94.7

(2.2)

97.0

(1.9)

97.6

(1.2)

98.2

( 1.2)

Kansas

90.4

(4.1)

96.2

(2.6)

97.3

(1.6)

98.9

( 1.2)

Kentucky

88.0

(3.0)

95.3

(2.1)

95.1

(1.7)

94.7

( 2.8)

Louisiana

86.9

(5.3)

95.9

(3.4)

95.4

(3.1)

94.6

( 6.2)

Maine

91.4

(4.1)

94.7

(3.4)

94.5

(2.5)

94.1

( 3.9)

Maryland

93.8

(2.3)

96.2

(2.1)

96.8

(1.5)

98.1

( 2.1)

Massachusetts

94.5

(4.4)

95.9

(3.8)

97.1

(2.4)

98.9

( 1.5)

Michigan

94.3

(2.8)

97.0

(2.2)

97.1

(1.6)

97.4

( 2.2)

Minnesota

94.7

(1.9)

96.4

(1.7)

95.9

(1.3)

95.1

( 2.1)

Mississippi

86.2

(4.9)

93.4

(3.5)

93.5

(2.7)

93.6

( 4.5)

Missouri

90.2

(4.0)

96.7

(3.0)

97.0

(2.1)

97.6

( 2.7)

Montana

92.3

(4.0)

93.3

(3.8)

93.7

(2.7)

94.3

( 3.6)

Nebraska

93.1

(3.0)

97.0

(1.7)

97.5

(1.2)

98.0

( 1.6)

Nevada

89.2

(7.2)

97.4

(2.3)

98.0

(1.7)

99.8

( 0.4)

New Hampshire

93.6

(3.8)

94.3

(3.7)

95.2

(2.6)

96.6

( 3.1)

New Jersey

90.6

(3.7)

94.1

(2.8)

94.6

(2.0)

95.4

( 2.8)

New Mexico

88.4

(5.1)

97.1

(2.3)

96.0

(2.2)

94.1

( 4.4)

New York

91.6

(3.4)

93.8

(2.9)

94.9

(2.0)

96.6

( 2.4)

North Carolina

89.3

(3.2)

92.4

(2.6)

93.4

(1.9)

95.4

( 2.4)

North Dakota

94.3

(3.1)

97.0

(2.1)

96.8

(1.7)

96.6

( 2.8)

Ohio

92.1

(3.3)

97.2

(1.6)

96.9

(1.4)

96.4

( 2.9)

Oklahoma

91.6

(4.1)

99.1

(1.0)

99.0

(0.9)

98.5

( 2.1)

Oregon

92.6

(2.8)

97.0

(1.8)

97.6

(1.2)

98.6

( 1.5)

Pennsylvania

92.1

(2.7)

98.2

(1.1)

98.0

(1.0)

97.6

( 1.9)

Rhode Island

94.4

(3.5)

98.1

(1.8)

97.3

(1.6)

96.0

( 2.9)

South Carolina

93.8

(3.4)

96.0

(2.4)

96.2

(1.9)

96.7

( 2.9)

South Dakota

94.1

(3.4)

95.6

(2.5)

95.4

(1.8)

95.1

( 2.6)

Tennessee

91.1

(2.8)

94.8

(2.7)

95.9

(1.8)

97.6

( 1.8)

Texas

90.5

(3.6)

95.3

(3.0)

95.9

(2.1)

96.8

( 2.7)

Utah

93.2

(4.2)

93.4

(4.0)

95.4

(2.4)

98.0

( 2.0)

Vermont

93.7

(2.6)

97.0

(1.8)

96.5

(1.6)

95.7

( 2.8)

Virginia

92.3

(2.5)

95.8

(2.2)

95.6

(2.0)

95.2

( 4.0)

Washington

94.3

(2.5)

96.4

(2.3)

96.9

(1.6)

97.6

( 2.3)

West Virginia

85.6

(4.1)

95.0

(2.4)

95.6

(1.8)

96.6

( 2.4)

Wisconsin

95.8

(3.4)

98.0

(1.6)

98.4

(1.1)

99.0

( 1.4)

Wyoming

92.5

(3.0)

96.0

(3.0)

97.2

(2.0)

99.2

( 1.1)

Median

92.3%

96.2%

96.6%

97.0%

Range

(73.7%-95.9%)

(82.9%-99.1%)

(73.6%-99.0%)

(71.3%-99.8%)

* n = 42,692.
† Respondents were asked, "Was there any time in the last 12 months when you needed to see a doctor but could not because of the cost?" Persons who answered no are reported.
Confidence interval. CIs were calculated by multiplying the standard error by 1.96.


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Table 5

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TABLE 5. Percentage of Medicare beneficiaries aged >=65 years who reported difficulty accessing medical care, by selected sociodemographic characteristics -- United States, Medicare Current Beneficiary Study (MCBS), 1996*

 

Had difficulty getting medical care

Did not get prescribed medications

Delayed care because of cost

Not satisfied with ease of getting to doctor

No specific source for care

No specific doctor seen at specific site

Characteristics

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Sex

                       

Male

2.2

(0.5)

2.1

(0.5)

5.3

(0.8)

4.7

(0.8)

7.7

(0.9)

12.3

(1.1)

Female

2.5

(0.4)

2.8

(0.5)

6.9

(0.7)

5.2

(0.7)

6.3

(0.8)

8.8

(0.8)

Race/Sex

                       

White male

2.1

(0.5)

2.0

(0.9)

4.7

(0.7)

4.7

(0.9)

7.4

(1.0)

11.3

(1.2)

White female

2.4

(0.4)

2.7

(0.6)

6.5

(0.7)

4.8

(0.7)

6.0

(0.8)

8.0

(0.9)

Black male

2.8

(1.7)**

2.4

(1.5)**

9.3

(2.8)

3.7

(0.9)

11.1

(3.7)

23.6

(5.5)

Black female

4.1

(1.6)

4.7

(2.5)

11.1

(3.3)

8.3

(2.5)

8.7

(3.1)

15.6

(3.6)

Age (yrs)

                       

65-74

2.6

(0.5)

2.8

(0.5)

6.8

(0.8)

4.4

(0.8)

7.7

(0.8)

11.6

(1.0)

75-84

1.9

(0.4)

2.1

(0.4)

5.0

(0.7)

5.8

(0.9)

6.1

(0.9)

9.1

(1.0)

>=85

2.3

(0.7)

1.0

(0.4)

3.7

(1.0)

6.8

(1.4)

5.1

(1.2)

7.7

(1.5)

Income

                       

>$25,000

2.0

(0.4)

1.7

(0.5)

2.3

(0.6)

2.9

(0.6)

5.2

(0.8)

7.5

(1.1)

<=$25,000

2.6

(0.4)

2.9

(0.6)

8.5

(1.0)

6.0

(0.9)

8.4

(0.7)

13.1

(1.0)

<=$15,000

3.3

(0.7)

3.0

(0.7)

10.3

(1.3)

6.8

(1.3)

9.8

(1.1)

15.8

(1.6)

<=$10,000

4.0

(1.0)

3.3

(0.9)

11.2

(1.6)

7.3

(1.7)

11.0

(1.6)

18.9

(2.3)

* n = 17,794.
† Based on noninstitutionalized U.S. residents responding to the 1996 MCBS. Results are age-adjusted within race/sex strata, sex-adjusted within age strata, and age- and sex-adjusted within income strata to the 1970 U.S. standard population.
Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Race/ethnicity data are presented only for non-Hispanic whites and non-Hispanic blacks because sample sizes for other racial/ethnic groups were too small for meaningful analysis.
** Estimates might be unstable (relative standard error 0.3) because of small sample size.


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Table 6

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TABLE 6. Percentage of adults aged >=55 years who reported receiving a blood pressure check during the preceding 2 years, by state and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age groups (yrs)

 

55-64

65-74

>=65

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

97.3

(2.1)

99.0

(1.0)

98.2

(1.3)

96.9

(3.0)

Alaska

97.6

(1.8)

96.1

(3.8)

96.6

(3.0)

98.4

(2.4)

Arizona

96.1

(2.1)

98.0

(1.4)

98.6

(0.9)

99.5

(0.7)

Arkansas

94.7

(2.9)

98.3

(1.8)

97.4

(1.6)

96.3

(2.7)

California

94.9

(2.2)

97.5

(1.3)

97.3

(1.2)

97.1

(2.3)

Colorado

93.1

(3.7)

95.0

(3.4)

96.5

(2.3)

99.4

(1.2)

Connecticut

95.7

(2.7)

94.2

(4.6)

96.1

(2.9)

98.9

(1.7)

Delaware

97.3

(2.0)

98.7

(1.1)

98.3

(1.1)

97.7

(2.3)

District of Columbia

98.2

(2.3)

99.3

(1.3)

99.6

(0.8)

100.0

(0.0)

Florida

93.5

(2.7)

97.3

(1.5)

98.0

(1.0)

98.8

(1.1)

Georgia

97.1

(2.6)

98.1

(1.9)

98.7

(1.3)

100.0

(0.0)

Hawaii

96.4

(2.8)

96.1

(3.1)

95.6

(2.5)

94.6

(4.3)

Idaho

94.5

(1.9)

95.3

(1.9)

95.9

(1.4)

96.6

(2.1)

Illinois

93.4

(4.2)

98.9

(1.6)

98.8

(1.2)

98.6

(1.9)

Indiana

96.1

(2.4)

95.6

(3.1)

96.6

(2.0)

98.0

(1.8)

Iowa

94.0

(2.6)

95.4

(2.2)

95.8

(1.5)

96.2

(2.1)

Kansas

94.5

(3.6)

97.8

(1.9)

97.9

(1.5)

97.9

(2.5)

Kentucky

94.5

(2.5)

97.5

(1.4)

97.7

(1.0)

98.2

(1.2)

Louisiana

92.2

(4.8)

95.9

(3.5)

96.9

(2.3)

98.8

(1.7)

Maine

96.3

(2.6)

95.3

(3.6)

96.4

(2.3)

98.0

(2.3)

Maryland

96.8

(1.9)

98.3

(1.3)

98.6

(0.9)

99.1

(0.8)

Massachusetts

97.4

(2.3)

96.4

(3.1)

96.4

(2.2)

96.4

(3.0)

Michigan

98.4

(1.4)

96.0

(3.4)

96.1

(2.3)

96.2

(3.1)

Minnesota

93.1

(2.3)

96.7

(1.6)

96.8

(1.2)

96.8

(1.7)

Mississippi

97.5

(2.2)

98.9

(1.6)

98.2

(1.7)

97.0

(3.5)

Missouri

96.5

(2.5)

98.3

(2.1)

98.5

(1.5)

98.9

(1.8)

Montana

94.5

(3.0)

91.0

(4.5)

94.5

(2.8)

99.2

(1.6)

Nebraska

93.0

(3.4)

95.5

(2.3)

95.5

(1.7)

95.4

(2.6)

Nevada

94.1

(5.0)

96.8

(3.0)

96.4

(2.9)

95.3

(6.9)

New Hampshire

95.1

(3.6)

96.1

(3.6)

96.9

(2.4)

98.1

(2.7)

New Jersey

95.5

(3.3)

96.3

(2.3)

96.5

(1.7)

96.9

(2.4)

New Mexico

90.9

(4.1)

95.0

(3.4)

95.5

(2.4)

96.5

(2.9)

New York

95.0

(2.4)

97.4

(1.8)

97.1

(1.4)

96.6

(2.3)

North Carolina

96.4

(2.1)

96.8

(1.8)

97.0

(1.4)

97.5

(2.2)

North Dakota

92.4

(4.4)

94.6

(3.4)

96.2

(2.1)

98.3

(1.8)

Ohio

97.1

(2.1)

96.9

(2.3)

97.4

(1.6)

98.5

(1.5)

Oklahoma

96.4

(2.7)

98.3

(1.3)

98.6

(1.0)

99.5

(1.0)

Oregon

94.4

(2.4)

96.0

(2.2)

95.9

(1.6)

95.7

(2.5)

Pennsylvania

96.0

(1.9)

96.7

(1.9)

97.4

(1.3)

98.5

(1.3)

Rhode Island

97.6

(2.0)

97.4

(2.5)

97.0

(2.0)

96.3

(3.3)

South Carolina

98.7

(1.4)

99.4

(0.9)

99.4

(0.7)

99.5

(1.0)

South Dakota

92.9

(3.4)

96.9

(2.2)

96.8

(1.6)

96.7

(2.4)

Tennessee

95.4

(2.5)

96.7

(2.4)

97.7

(1.6)

99.2

(1.5)

Texas

93.3

(3.9)

98.2

(2.2)

97.5

(1.9)

96.4

(3.5)

Utah

94.3

(4.0)

96.4

(2.5)

96.9

(1.6)

97.6

(1.9)

Vermont

94.7

(2.3)

95.3

(2.5)

97.0

(1.5)

99.4

(0.8)

Virginia

95.7

(2.3)

97.6

(1.9)

98.1

(1.3)

98.9

(1.1)

Washington

94.0

(3.0)

94.7

(2.5)

95.1

(2.0)

95.6

(3.1)

West Virginia

97.0

(1.8)

99.0

(1.0)

98.2

(1.2)

96.9

(2.8)

Wisconsin

89.0

(4.7)

95.7

(3.2)

96.3

(2.3)

97.3

(3.2)

Wyoming

92.2

(3.5)

94.5

(3.0)

94.9

(2.3)

95.6

(3.4)

Median

95.1%

96.7%

97.0%

97.7%

Range

(89.0%-98.7%)

(91.0%-99.4%)

(94.5%-99.6%)

(94.6%-100.0%)

* n = 41,328.
† Respondents were asked, "About how long has it been since you last had your blood pressure taken by a doctor, nurse, or other health professional?" Persons whose blood pressure had been checked during the preceding 2 years are reported.
Confidence interval. CIs were calculated by multiplying the standard error by 1.96.


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Table 7

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TABLE 7. Percentage of adults aged >=55 years who reported receiving a blood cholesterol check during the preceding 5 years, by state and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age group (yrs)

 

55-64

65-74

>=65

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

85.7

(4.7)

84.9

( 6.1)

84.4

(4.4)

83.5

( 6.3)

Alaska

84.1

(8.3)

81.3

(11.2)

80.0

(9.8)

75.6

(20.1)

Arizona

86.9

(5.0)

88.3

( 4.2)

88.8

(3.6)

89.5

( 5.3)

Arkansas

75.5

(6.1)

80.8

( 5.8)

79.3

(4.7)

77.0

( 7.8)

California

86.7

(3.6)

92.8

( 2.8)

90.9

(2.4)

88.1

( 4.1)

Colorado

88.3

(4.8)

89.4

( 4.6)

88.1

(3.7)

85.4

( 6.3)

Connecticut

86.9

(8.4)

88.1

( 4.2)

86.4

(3.7)

83.7

( 6.6)

Delaware

84.6

(4.5)

91.7

( 3.0)

92.0

(2.4)

92.5

( 3.9)

District of Columbia

87.6

(5.0)

89.6

( 5.3)

91.0

(3.8)

93.2

( 5.3)

Florida

86.9

(3.9)

93.4

( 2.3)

92.9

(1.8)

92.3

( 2.8)

Georgia

85.6

(4.8)

88.8

( 4.6)

89.1

(3.8)

90.0

( 6.4)

Hawaii

89.0

(5.1)

89.9

( 4.6)

87.5

(4.1)

83.7

( 7.6)

Idaho

81.8

(3.6)

85.5

( 3.3)

86.6

(2.4)

88.2

( 3.5)

Illinois

81.2

(6.8)

91.4

( 4.5)

90.4

(3.6)

88.6

( 6.4)

Indiana

86.1

(4.2)

84.6

( 5.2)

84.7

(3.8)

84.8

( 5.6)

Iowa

78.8

(4.6)

85.8

( 3.7)

85.9

(2.6)

86.0

( 3.5)

Kansas

74.9

(6.5)

73.9

( 6.2)

71.7

(4.8)

68.3

( 7.3)

Kentucky

80.9

(4.1)

83.4

( 3.7)

83.3

(2.9)

83.3

( 4.4)

Louisiana

77.8

(7.1)

85.4

( 5.5)

85.1

(4.7)

84.4

( 8.8)

Maine

86.6

(4.9)

84.8

( 5.7)

85.8

(4.2)

87.3

( 6.0)

Maryland

86.4

(3.7)

89.4

( 3.6)

89.1

(2.9)

88.5

( 4.8)

Massachusetts

86.3

(6.2)

83.6

( 6.0)

84.4

(4.3)

85.5

( 6.0)

Michigan

94.9

(2.5)

91.6

( 4.1)

87.9

(3.4)

82.9

( 5.7)

Minnesota

78.2

(3.9)

83.7

( 3.5)

81.6

(2.7)

78.9

( 4.1)

Mississippi

76.3

(7.1)

85.0

( 6.2)

85.0

(4.6)

84.9

( 7.0)

Missouri

81.5

(5.5)

89.6

( 4.3)

89.5

(3.4)

89.1

( 5.6)

Montana

81.1

(5.6)

78.7

( 6.2)

79.8

(4.5)

81.3

( 6.2)

Nebraska

80.2

(5.3)

82.7

( 4.5)

82.2

(3.3)

81.6

( 4.9)

Nevada

87.9

(6.1)

90.1

( 5.9)

89.6

(5.6)

88.4

(13.2)

New Hampshire

92.9

(3.7)

89.8

( 5.3)

88.3

(4.1)

85.8

( 6.8)

New Jersey

87.4

(4.9)

87.3

( 4.3)

86.4

(3.5)

84.8

( 6.0)

New Mexico

76.6

(6.4)

87.2

( 4.8)

85.8

(3.9)

83.4

( 6.6)

New York

90.0

(3.5)

90.7

( 3.4)

87.3

(3.0)

81.9

( 5.4)

North Carolina

89.4

(3.2)

91.2

( 2.8)

88.9

(2.5)

84.3

( 4.8)

North Dakota

80.1

(6.3)

83.8

( 5.4)

85.7

(3.6)

88.3

( 4.6)

Ohio

85.1

(4.8)

88.3

( 3.6)

86.9

(3.0)

83.9

( 5.2)

Oklahoma

84.4

(5.6)

83.1

( 4.0)

84.1

(3.3)

87.0

( 5.2)

Oregon

88.2

(3.5)

92.1

( 3.1)

91.1

(2.4)

89.4

( 4.0)

Pennsylvania

83.3

(4.0)

85.6

( 3.8)

84.0

(3.0)

81.4

( 4.9)

Rhode Island

88.1

(5.1)

90.2

( 4.7)

90.3

(3.4)

90.4

( 4.6)

South Carolina

85.6

(4.7)

88.0

( 4.2)

89.0

(3.2)

91.0

( 4.6)

South Dakota

80.0

(6.0)

86.3

( 4.5)

82.6

(3.4)

77.7

( 5.5)

Tennessee

83.4

(4.1)

88.8

( 3.8)

86.6

(3.2)

83.0

( 5.3)

Texas

84.5

(5.2)

93.1

( 3.6)

90.1

(3.5)

84.8

( 7.2)

Utah

81.7

(6.2)

88.5

( 5.3)

86.3

(4.1)

83.3

( 6.2)

Vermont

84.4

(4.1)

83.2

( 4.3)

84.6

(3.2)

86.7

( 4.6)

Virginia

88.0

(3.7)

91.4

( 3.2)

92.0

(2.7)

93.1

( 4.9)

Washington

86.9

(4.0)

89.2

( 3.6)

87.7

(3.0)

85.5

( 5.2)

West Virginia

82.8

(4.8)

90.4

( 3.6)

88.8

(2.9)

85.9

( 5.2)

Wisconsin

83.9

(5.1)

90.4

( 4.2)

87.4

(4.2)

82.2

( 8.6)

Wyoming

89.3

(4.0)

88.2

( 4.6)

89.4

(3.4)

91.4

( 4.7)

Median

84.9%

88.3%

86.8%

85.2%

Range

(74.9%-94.9%)

(73.9%-91.6%)

(71.7%-92.9%)

(68.3%-93.2%)

* n = 39,843.
† Respondents were asked, "About how long has it been since you last had your blood cholesterol checked?" Persons whose blood cholesterol had been checked during the preceding 5 years are reported.
Confidence interval. CIs were calculated by multiplying the standard error by 1.96.


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Table 8

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TABLE 8. Percentage of women aged >=55 years who reported receiving a mammogram during the preceding 2 years, by state and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age group (yrs)

 

55-64

65-74

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

74.3

( 7.1)

78.4

( 6.7)

62.3

( 9.4)

Alaska

90.7

( 8.5)

74.2

(15.7)

 

Arizona

74.1

(11.4)

75.4

( 9.2)

71.1

(10.5)

Arkansas

57.3

( 8.8)

55.7

( 8.6)

50.3

( 9.6)

California

80.4

( 5.8)

80.8

( 5.6)

70.8

( 6.5)

Colorado

78.3

( 8.2)

73.8

( 8.6)

68.7

(10.2)

Connecticut

87.1

( 5.9)

75.4

( 9.2)

65.5

( 9.4)

Delaware

83.3

( 5.7)

77.1

( 6.1)

66.6

( 8.9)

District of Columbia

82.3

( 7.6)

83.8

( 8.0)

75.3

(11.0)

Florida

79.3

( 5.5)

81.5

( 4.5)

72.8

( 6.2)

Georgia

75.1

( 7.7)

79.4

( 7.4)

58.6

(12.1)

Hawaii

84.8

( 7.5)

82.2

( 7.0)

75.1

( 9.6)

Idaho

66.6

( 8.1)

66.6

( 5.7)

54.7

( 6.6)

Illinois

76.2

( 6.7)

76.1

( 6.5)

55.7

( 8.6)

Indiana

74.9

( 8.1)

70.3

( 8.0)

37.9

( 9.6)

Iowa

77.1

( 5.5)

66.6

( 5.9)

53.8

( 6.2)

Kansas

71.8

( 8.9)

68.5

( 8.0)

65.4

( 8.3)

Kentucky

72.2

( 5.6)

70.5

( 5.4)

57.5

( 5.8)

Louisiana

69.9

( 9.4)

80.8

( 8.3)

53.6

(11.8)

Maine

77.1

( 8.9)

84.4

( 7.5)

63.1

(10.3)

Maryland

80.8

( 6.1)

81.4

( 5.8)

66.3

( 9.1)

Massachusetts

85.6

(10.3)

77.8

( 8.5)

65.7

(10.7)

Michigan

81.4

( 6.2)

82.6

( 6.7)

70.0

( 8.4)

Minnesota

82.0

( 4.9)

77.3

( 5.1)

56.0

( 5.7)

Mississippi

67.0

( 8.6)

68.4

( 8.4)

50.4

(10.2)

Missouri

72.1

( 8.6)

71.4

( 9.2)

60.9

( 9.9)

Montana

70.3

( 7.8)

70.8

( 8.9)

69.2

( 8.3)

Nebraska

77.8

( 6.5)

65.3

( 7.6)

54.4

( 7.0)

Nevada

77.0

(10.1)

74.8

(11.2)

39.4

(23.8)

New Hampshire

86.0

( 7.2)

79.6

( 9.8)

66.0

(10.9)

New Jersey

77.2

( 7.3)

74.9

( 6.9)

58.7

( 9.3)

New Mexico

71.6

( 8.9)

70.8

( 8.7)

56.9

(10.5)

New York

84.2

( 5.4)

78.4

( 5.9)

70.0

( 7.8)

North Carolina

76.6

( 5.6)

78.0

( 5.3)

59.3

( 7.1)

North Dakota

71.5

( 8.4)

77.7

( 7.7)

64.4

( 7.8)

Ohio

76.0

( 7.4)

76.6

( 6.5)

57.3

( 9.4)

Oklahoma

77.9

( 8.4)

60.0

( 7.7)

52.1

( 9.4)

Oregon

84.0

( 5.3)

82.0

( 5.2)

66.4

( 7.4)

Pennsylvania

81.0

( 4.9)

71.5

( 6.1)

63.4

( 7.0)

Rhode Island

84.8

( 7.1)

87.4

( 5.7)

71.3

( 9.2)

South Carolina

74.1

( 7.3)

82.1

( 5.5)

63.2

( 9.4)

South Dakota

71.8

( 8.8)

75.7

( 7.1)

61.3

( 7.9)

Tennessee

77.5

( 5.7)

70.9

( 6.3)

64.5

( 7.8)

Texas

66.9

( 7.8)

71.5

( 8.1)

52.2

(11.1)

Utah

73.2

( 9.4)

74.1

( 9.3)

61.4

(10.2)

Vermont

75.1

( 7.1)

75.3

( 6.5)

61.4

( 8.3)

Virginia

79.7

( 5.7)

74.9

( 7.3)

57.2

(10.7)

Washington

79.2

( 6.2)

72.8

( 6.7)

61.3

( 8.0)

West Virginia

72.3

( 7.1)

69.5

( 6.5)

60.6

( 7.6)

Wisconsin

72.4

( 9.1)

75.9

( 7.4)

54.5

(10.6)

Wyoming

70.7

( 7.0)

73.0

( 8.0)

64.8

( 9.0)

Median

77.0%

75.4%

61.4%

Range

(57.3%-90.73%)

(55.7%-87.4%)

(37.9%-75.3%)

* n = 26,408.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Insufficient number of respondents.
Estimate might be unstable (relative standard error 0.3) because of small sample size.


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Table 9

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TABLE 9. Percentage of women aged >=55 years who reported receiving a Papanicalaou test during the preceding 3 years, by state and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age groups (yrs)

 

55-64

65-74

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

85.0

( 8.3)

75.3

( 9.5)

61.7

(12.9)

Alaska

88.5

(13.9)

78.0

(20.6)

 

Arizona

66.8

(15.4)

74.0

(12.9)

71.8

(13.8)

Arkansas

69.9

(12.3)

67.2

(11.0)

51.1

(12.6)

California

85.7

( 6.7)

84.2

( 8.3)

64.8

( 9.4)

Colorado

87.0

( 9.8)

78.6

(11.5)

64.8

(14.3)

Connecticut

82.0

( 8.6)

76.3

(13.3)

53.8

(13.3)

Delaware

83.7

( 6.8)

83.2

( 6.7)

63.8

(12.0)

District of Columbia

92.0

( 5.9)

82.9

(10.7)

81.8

(11.9)

Florida

87.4

( 6.6)

84.4

( 5.8)

64.2

( 8.8)

Georgia

86.2

( 8.6)

88.5

( 7.5)

66.1

(13.3)

Hawaii

83.4

(11.6)

81.4

( 8.9)

74.6

(13.4)

Idaho

81.8

( 6.4)

72.6

( 7.9)

47.2

( 9.1)

Illinois

84.4

( 7.1)

68.3

( 8.6)

45.4

(10.8)

Indiana

84.4

( 9.7)

70.0

(11.2)

45.1

(13.0)

Iowa

77.5

( 7.3)

70.5

( 7.4)

56.2

( 7.7)

Kansas

79.0

(11.9)

79.4

( 8.2)

66.4

(10.1)

Kentucky

69.0

( 8.2)

77.0

( 7.0)

59.2

( 8.3)

Louisiana

75.6

(13.0)

74.4

(13.4)

53.8

(18.5)

Maine

84.0

( 9.3)

80.8

(11.1)

69.4

(12.3)

Maryland

87.9

( 5.8)

80.2

( 6.9)

51.5

(12.8)

Massachusetts

91.7

( 7.1)

77.4

(10.3)

59.8

(15.1)

Michigan

88.1

( 7.0)

87.6

( 7.4)

54.5

(12.0)

Minnesota

83.1

( 5.8)

82.0

( 5.7)

61.0

( 7.3)

Mississippi

84.1

( 8.5)

74.8

(11.0)

40.7

(15.7)

Missouri

82.0

( 9.0)

74.1

(11.7)

52.3

(12.7)

Montana

75.2

(10.7)

77.8

(11.8)

58.4

(11.1)

Nebraska

83.2

( 7.6)

69.0

(10.0)

50.0

( 9.1)

Nevada

80.6

(14.2)

65.7

(18.6)

 

N. Hampshire

88.7

( 8.1)

79.7

(14.4)

59.7

(15.8)

New Jersey

79.4

( 8.1)

73.9

( 8.4)

52.8

(12.0)

New Mexico

68.8

(14.0)

72.0

(11.3)

61.8

(14.1)

New York

85.5

( 6.6)

72.2

( 7.6)

68.1

( 9.2)

N. Carolina

84.0

( 6.8)

80.1

( 7.3)

58.2

(10.1)

North Dakota

82.5

( 9.1)

80.0

( 9.6)

57.0

(10.5)

Ohio

90.4

( 5.7)

83.6

( 6.5)

55.9

(11.6)

Oklahoma

77.7

(12.4)

79.5

(10.6)

56.2

(14.5)

Oregon

86.4

( 7.8)

82.9

( 7.8)

72.5

( 9.5)

Pennsylvania

82.2

( 6.0)

68.8

( 7.8)

47.5

( 9.5)

Rhode Island

85.5

( 8.2)

81.9

( 9.3)

50.9

(13.0)

S. Carolina

80.1

(10.4)

89.1

( 6.1)

72.8

(10.4)

South Dakota

85.0

( 7.6)

75.5

( 8.6)

60.9

( 9.9)

Tennessee

85.3

( 6.4)

79.6

( 7.4)

70.0

( 9.9)

Texas

73.4

(11.1)

73.5

(11.2)

49.6

(16.2)

Utah

74.9

(13.8)

75.6

(13.3)

57.7

(14.6)

Vermont

82.8

( 7.0)

72.3

( 7.9)

52.7

(12.3)

Virginia

88.5

( 6.3)

78.7

( 7.5)

73.3

(11.5)

Washington

88.3

( 6.5)

73.4

( 9.4)

49.6

(11.6)

W. Virginia

74.6

( 8.3)

67.8

( 9.1)

57.0

(10.3)

Wisconsin

69.7

(11.4)

74.2

(10.2)

50.8

(12.3)

Wyoming

77.7

( 9.3)

83.6

(10.3)

66.0

(11.4)

Median

83.4%

77.4%

58.2%

Range

(66.8%-92.0%)

(65.7%-89.1%)

(40.7%-81.8%)

* n = 14,592 (excludes all women without a uterus).
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Insufficient number of respondents.


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Table 10

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TABLE 10. Percentage of adults aged >=55 years who reported receiving a fecal occult blood test during the preceding 2 years, by state, sex and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age group (yrs)

 

Men

Women

Total

 

55-64

>=65

55-64

>=65

55-64

65-74

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

17.9

( 8.4)

17.3

( 7.4)

19.9

( 6.5)

19.5

( 5.0)

19.0

( 5.3)

15.8

( 5.3)

23.0

( 7.4)

Alaska

30.6

(16.2)

20.3

(14.3)

33.0

(15.3)

32.5

(15.3)

31.8

(11.2)

24.5

(12.3)

33.5

(21.0)

Arizona

28.8

(11.3)

35.8

( 8.6)

21.9

( 9.0)

30.6

( 7.4)

25.2

( 7.6)

38.3

( 7.4)

25.0

( 7.9)

Arkansas

17.2

( 7.7)

30.5

( 8.8)

23.7

( 7.8)

19.6

( 5.4)

20.6

( 5.5)

22.4

( 6.2)

26.2

( 7.6)

California

15.2

( 5.2)

25.7

( 5.4)

28.5

( 6.0)

31.3

( 4.8)

22.1

( 4.0)

30.2

( 4.9)

27.2

( 5.2)

Colorado

31.1

(10.1)

39.7

(10.2)

35.9

(10.0)

31.8

( 6.9)

33.6

( 7.1)

36.7

( 7.7)

32.1

( 8.7)

Connecticut

37.0

(13.1)

33.6

( 7.7)

27.8

( 8.7)

35.2

( 6.6)

32.2

( 7.7)

34.8

( 6.6)

34.1

( 7.6)

Delaware

37.9

(10.4)

30.5

( 7.3)

27.9

( 7.1)

32.7

( 5.6)

32.7

( 6.2)

32.5

( 5.5)

30.6

( 7.1)

District of Columbia

38.9

( 8.4)

40.6

( 7.1)

44.2

(11.6)

41.8

( 8.5)

38.9

( 8.4)

46.0

( 9.4)

32.0

(10.1)

Florida

22.2

( 6.6)

34.2

( 5.3)

26.5

( 6.3)

37.8

( 4.3)

24.5

( 4.6)

35.7

( 4.4)

37.1

( 4.9)

Georgia

33.6

( 6.7)

27.2

( 5.2)

32.9

( 8.3)

29.0

( 7.0)

33.6

( 6.7)

29.9

( 6.6)

20.9

( 8.3)

Hawaii

26.1

(10.7)

33.0

( 8.4)

37.5

(10.4)

39.3

( 7.4)

32.0

( 7.5)

34.9

( 7.2)

38.8

( 8.8)

Idaho

21.1

( 7.2)

24.5

( 5.5)

27.3

( 6.2)

32.5

( 4.4)

24.2

( 4.6)

30.8

( 4.7)

26.7

( 4.9)

Illinois

16.9

( 9.0)

35.2

(11.3)

28.3

( 9.5)

28.7

( 7.1)

23.1

( 6.6)

35.2

( 7.9)

23.5

( 9.2)

Indiana

16.1

( 6.7)

21.6

( 7.1)

28.3

( 8.6)

23.8

( 5.7)

22.1

( 5.5)

27.1

( 6.3)

17.1

( 5.8)

Iowa

23.5

( 6.3)

30.2

( 6.6)

30.2

( 6.4)

28.9

( 4.2)

27.0

( 4.6)

31.0

( 5.3)

27.5

( 5.1)

Kansas

38.2

(10.7)

29.7

( 8.7)

30.8

( 8.9)

32.7

( 6.0)

34.3

( 6.9)

35.1

( 7.0)

26.3

( 6.9)

Kentucky

24.5

( 6.8)

28.7

( 6.1)

26.9

( 5.5)

30.6

( 4.2)

25.8

( 4.3)

32.3

( 4.8)

25.6

( 4.9)

Louisiana

20.3

( 9.9)

27.2

( 8.7)

17.7

( 7.6)

32.8

( 7.3)

18.9

( 6.4)

32.4

( 7.0)

27.0

( 9.4)

Maine

30.0

( 9.9)

34.8

( 8.6)

37.5

( 9.7)

45.6

( 7.9)

33.9

( 6.9)

39.9

( 8.0)

43.0

( 9.0)

Maryland

26.5

( 7.3)

40.8

( 6.8)

28.9

( 6.7)

35.9

( 5.2)

27.8

( 4.8)

39.0

( 5.3)

35.9

( 6.8)

Massachusetts

26.5

(12.1)

31.2

( 9.7)

34.9

(10.7)

44.3

( 7.8)

31.0

( 8.1)

41.1

( 8.1)

35.5

( 9.5)

Michigan

33.6

( 9.5)

26.8

( 7.8)

36.6

( 7.7)

36.1

( 6.3)

35.2

( 6.1)

34.2

( 6.8)

29.7

( 7.1)

Minnesota

28.4

( 6.0)

36.6

( 5.9)

36.3

( 6.4)

37.5

( 4.3)

32.5

( 4.3)

41.0

( 4.8)

32.4

( 4.7)

Mississippi

12.8

( 7.4)

7.8

( 5.2)

13.1

( 6.4)

21.0

( 5.8)

12.9

( 5.0)

16.4

( 5.3)

14.8

( 6.6)

Missouri

23.7

(10.0)

25.6

( 8.0)

34.5

( 9.3)

26.6

( 5.9)

29.3

( 6.8)

23.0

( 5.8)

31.1

( 7.6)

Montana

24.8

(10.0)

16.7

( 6.4)

32.0

( 8.3)

26.6

( 6.2)

28.5

( 6.5)

21.6

( 6.1)

23.4

( 7.0)

Nebraska

20.6

( 9.0)

24.6

( 6.4)

21.7

( 6.3)

31.3

( 5.1)

21.2

( 5.4)

31.2

( 5.8)

25.5

( 5.3)

Nevada

13.1

( 9.5)

25.2

(17.4)

13.7

( 7.1)

20.6

( 9.3)

13.4

( 5.9)

24.2

(11.5)

18.7

(16.0)

New Hampshire

32.9

(14.2)

31.9

( 9.2)

34.5

(10.1)

46.4

( 8.4)

33.7

( 8.7)

42.6

( 8.3)

36.3

( 9.4)

New Jersey

27.5

( 9.6)

28.1

( 7.2)

34.1

( 8.2)

30.7

( 5.9)

31.0

( 6.3)

32.0

( 6.0)

25.8

( 6.9)

New Mexico

16.1

( 8.6)

22.5

( 7.8)

19.1

( 7.6)

29.4

( 6.9)

17.7

( 5.7)

24.8

( 6.4)

29.1

( 8.6)

New York

36.7

( 8.8)

35.3

( 7.6)

32.5

( 7.1)

31.7

( 5.1)

34.4

( 5.6)

31.7

( 5.5)

35.2

( 6.4)

North Carolina

35.4

( 8.0)

34.5

( 6.8)

43.9

( 6.6)

38.3

( 4.7)

40.0

( 5.2)

39.6

( 4.9)

31.5

( 6.1)

North Dakota

16.9

( 8.9)

20.8

( 6.8)

24.5

( 8.4)

30.1

( 5.9)

20.8

( 6.3)

25.4

( 6.1)

27.1

( 6.2)

Ohio

16.7

( 7.0)

38.9

( 7.8)

22.5

( 7.0)

37.2

( 5.6)

19.8

( 5.0)

41.8

( 5.8)

30.2

( 7.0)

Oklahoma

12.7

( 7.7)

7.6

( 3.4)

16.1

( 6.8)

17.8

( 4.8)

14.5

( 5.1)

13.6

( 3.8)

13.9

( 5.7)

Oregon

21.7

( 6.5)

33.5

( 7.0)

44.2

( 7.5)

47.6

( 5.3)

33.2

( 5.3)

46.8

( 5.7)

33.6

( 5.9)

Pennsylvania

26.5

( 7.6)

29.0

( 6.7)

27.6

( 5.7)

31.9

( 4.7)

27.1

( 4.7)

32.7

( 4.9)

27.8

( 6.3)

Rhode Island

22.2

( 9.5)

25.1

( 8.0)

24.4

( 8.6)

30.6

( 6.3)

23.3

( 6.4)

27.4

( 6.4)

30.3

( 7.7)

South Carolina

17.6

( 7.4)

28.7

( 7.6)

23.6

( 6.9)

29.5

( 5.4)

20.8

( 5.2)

28.1

( 5.5)

31.1

( 7.6)

South Dakota

19.8

( 8.3)

16.8

( 5.8)

19.3

( 7.3)

29.0

( 5.6)

19.6

( 5.4)

25.7

( 5.9)

21.5

( 5.5)

Tennessee

21.1

( 7.8)

22.1

( 7.2)

27.3

( 5.7)

27.5

( 4.9)

24.4

( 4.8)

28.2

( 5.5)

20.8

( 6.0)

Texas

24.5

( 8.9)

30.0

( 8.9)

28.5

( 7.4)

26.8

( 6.2)

26.6

( 5.7)

30.7

( 6.7)

23.6

( 8.1)

Utah

18.0

( 9.1)

21.7

( 8.1)

23.8

( 9.9)

25.0

( 6.9)

21.1

( 7.1)

21.2

( 7.2)

26.5

( 7.8)

Vermont

27.6

( 7.5)

40.0

( 7.1)

39.3

( 7.8)

44.0

( 5.8)

33.6

( 5.4)

44.8

( 5.8)

38.8

( 7.1)

Virginia

17.3

( 8.3)

27.8

( 9.2)

27.3

( 6.2)

27.3

( 6.9)

22.9

( 5.0)

27.9

( 6.8)

26.7

( 9.6)

Washington

28.6

( 7.3)

41.2

( 7.1)

39.9

( 7.4)

42.9

( 5.5)

34.3

( 5.2)

45.3

( 5.9)

37.8

( 6.5)

West Virginia

14.2

( 6.3)

21.5

( 6.4)

18.2

( 5.7)

21.3

( 4.5)

16.3

( 4.2)

22.4

( 4.8)

19.5

( 5.5)

Wisconsin

18.0

( 7.0)

28.0

( 8.8)

26.3

( 9.3)

32.3

( 6.7)

22.2

( 6.0)

35.1

( 7.2)

22.6

( 7.1)

Wyoming

14.2

( 6.8)

20.2

( 7.1)

21.9

( 6.3)

21.9

( 5.3)

18.1

( 4.7)

22.5

( 5.7)

18.9

( 6.4)

Median

23.5%

28.7%

27.9%

31.3%

25.8%

31.7%

27.2%

Range

(12.7%-38.9%)

(7.6%-41.2%)

(13.1%-44.2%)

(17.8%-47.6%)

(12.9%-40.0%)

(13.6%-46.8%)

(13.9%-43.0%)

* n = 43,692.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Estimates might be unstable (relative standard error 0.3) because of small sample size.


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Table 11

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TABLE 11. Percentage of adults aged >=55 years who reported ever receiving a proctoscopy or sigmoidoscopy, by state, sex, and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age group (yrs)

 

Men

Women

Total

 

55-64

>=65

55-64

>=65

55-64

65-74

>=75

State

%

(95% )

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

48.4

(10.0)

51.9

(10.0)

40.2

( 8.0)

45.9

( 6.4)

44.0

( 6.3)

49.4

( 6.9)

46.6

( 8.4)

Alaska

48.7

(16.9)

62.3

(16.9)

53.9

(15.8)

37.4

(15.6)

51.3

(11.5)

55.6

(13.4)

 

Arizona

40.7

(12.4)

48.9

(12.4)

30.4

( 8.0)

43.0

( 7.7)

35.3

( 8.8)

47.7

( 8.1)

42.4

( 8.8)

Arkansas

27.5

( 9.5)

51.4

( 9.5)

40.9

(15.8)

30.3

( 6.0)

34.6

( 6.6)

35.8

( 7.1)

42.9

( 8.4)

California

47.6

( 7.8)

61.7

( 7.8)

40.3

(12.5)

50.7

( 5.2)

43.8

( 5.3)

55.1

( 5.3)

55.3

( 6.1)

Colorado

45.1

(11.1)

63.4

(11.1)

40.3

( 8.8)

47.7

( 7.5)

42.6

( 7.4)

52.8

( 7.9)

57.0

( 9.2)

Connecticut

48.9

(14.2)

56.6

(14.2)

38.1

( 7.0)

48.7

( 7.1)

43.3

( 8.2)

49.0

( 7.0)

56.3

( 8.2)

Delaware

47.4

(10.4)

63.9

(10.4)

41.4

( 9.9)

52.8

( 5.8)

44.2

( 6.4)

57.3

( 5.7)

57.4

( 7.3)

District of Columbia

55.4

(13.0)

63.7

(13.0)

47.1

( 9.4)

51.8

( 8.8)

50.8

( 8.8)

58.0

( 9.0)

53.3

(11.0)

Florida

45.8

( 8.5)

59.6

( 8.5)

37.2

( 7.8)

48.8

( 4.4)

41.2

( 5.3)

52.7

( 4.7)

54.3

( 5.3)

Georgia

49.0

(10.5)

62.9

(10.5)

48.9

(11.6)

47.5

( 7.7)

48.9

( 7.0)

55.0

( 7.4)

50.1

( 9.7)

Hawaii

63.7

(10.6)

61.7

(10.6)

44.3

( 6.6)

56.0

( 7.4)

53.7

( 7.9)

58.2

( 7.3)

59.3

( 8.8)

Idaho

39.2

( 7.5)

48.7

( 7.5)

27.7

( 9.3)

44.3

( 4.6)

33.3

( 5.0)

45.8

( 5.0)

46.8

( 5.7)

Illinois

37.2

(11.3)

56.3

(11.3)

37.1

(10.8)

42.3

( 7.8)

37.2

( 7.9)

46.2

( 8.2)

50.5

(10.9)

Indiana

40.9

( 8.9)

48.0

( 8.9)

26.2

( 6.3)

40.6

( 6.6)

33.6

( 6.1)

43.8

( 6.8)

42.8

( 8.0)

Iowa

37.5

( 7.4)

58.1

( 7.4)

39.8

(10.8)

40.1

( 4.3)

38.7

( 4.9)

49.2

( 5.4)

44.8

( 5.6)

Kansas

43.0

(10.7)

42.9

(10.7)

30.9

( 7.4)

40.5

( 6.1)

36.7

( 6.9)

42.1

( 7.1)

40.5

( 7.8)

Kentucky

38.0

( 7.6)

41.1

( 7.6)

32.7

( 6.8)

35.8

( 4.3)

35.2

( 4.8)

41.1

( 5.1)

32.7

( 5.3)

Louisiana

36.1

(11.6)

42.0

(11.6)

30.5

( 8.7)

44.7

( 7.4)

33.1

( 7.5)

46.7

( 7.8)

38.1

( 9.3)

Maine

39.2

(10.7)

52.8

(10.7)

38.3

( 6.0)

47.4

( 7.7)

38.7

( 7.3)

49.2

( 8.0)

50.3

( 8.8)

Maryland

39.0

( 8.1)

55.9

( 8.1)

28.8

(10.1)

37.5

( 5.6)

33.5

( 5.3)

44.5

( 5.4)

46.4

( 7.6)

Massachusetts

57.3

(14.3)

52.6

(14.3)

37.8

( 9.6)

36.4

( 7.5)

46.9

( 9.1)

42.6

( 8.1)

43.6

( 9.6)

Michigan

46.7

( 9.8)

56.0

( 9.8)

49.4

( 6.6)

55.4

( 6.5)

48.1

( 6.3)

55.9

( 7.2)

55.2

( 7.7)

Minnesota

59.2

( 6.4)

62.3

( 6.4)

49.2

(10.8)

55.6

( 4.2)

54.0

( 4.5)

59.6

( 4.8)

56.8

( 5.1)

Mississippi

36.0

(12.0)

40.4

(12.0)

35.1

( 8.0)

40.3

( 6.5)

35.5

( 7.1)

38.3

( 7.3)

43.8

( 9.4)

Missouri

34.4

(10.3)

53.3

(10.3)

38.1

( 6.6)

46.9

( 6.7)

36.4

( 6.8)

47.2

( 7.6)

53.1

( 8.9)

Montana

33.1

(10.3)

45.9

(10.3)

39.0

( 8.6)

47.2

( 6.6)

36.1

( 6.8)

47.6

( 6.9)

45.4

( 7.9)

Nebraska

43.2

(11.1)

52.0

(11.1)

31.1

( 9.1)

40.9

( 5.3)

36.9

( 6.6)

48.5

( 6.3)

41.7

( 6.0)

Nevada

56.6

(14.5)

60.5

(14.5)

25.1

( 9.1)

33.8

(11.6)

40.7

(10.3)

50.1

(12.2)

34.6

(17.7)

New Hampshire

44.3

(14.7)

55.2

(14.7)

39.8

( 7.4)

42.0

( 8.3)

42.1

( 9.0)

51.8

( 8.4)

39.8

(10.4)

New Jersey

49.7

(11.6)

45.6

(11.6)

31.6

(10.4)

38.8

( 6.1)

40.3

( 6.9)

42.5

( 6.4)

39.7

( 7.5)

New Mexico

39.8

(11.2)

48.6

(11.2)

33.2

(10.8)

42.4

( 6.9)

36.4

( 7.3)

44.4

( 7.2)

46.2

( 9.2)

New York

48.7

( 9.2)

57.3

( 9.2)

37.0

( 7.8)

42.9

( 5.2)

42.4

( 5.8)

47.7

( 5.8)

49.9

( 6.9)

North Carolina

40.2

( 8.4)

45.2

( 8.4)

34.8

( 9.7)

43.4

( 4.8)

37.3

( 5.2)

43.2

( 5.0)

45.8

( 6.6)

North Dakota

50.7

(12.0)

53.5

(12.0)

31.9

( 7.4)

50.9

( 6.5)

41.0

( 7.5)

52.2

( 7.0)

51.7

( 7.2)

Ohio

36.1

( 8.7)

55.8

( 8.7)

31.4

( 6.5)

40.2

( 5.9)

33.6

( 5.7)

48.3

( 5.7)

42.5

( 7.6)

Oklahoma

26.9

(10.0)

15.3

(10.0)

26.8

( 8.6)

24.7

( 5.4)

26.8

( 6.6)

17.4

( 4.2)

30.6

( 7.4)

Oregon

53.0

( 8.2)

57.1

( 8.2)

43.2

( 8.0)

51.4

( 5.4)

47.9

( 5.5)

54.9

( 5.8)

51.8

( 6.5)

Pennsylvania

56.5

( 8.4)

45.1

( 8.4)

33.1

( 8.9)

37.8

( 5.0)

44.1

( 5.3)

41.7

( 5.2)

39.0

( 6.4)

Rhode Island

51.8

(11.3)

52.6

(11.3)

40.6

( 7.4)

40.6

( 6.9)

45.9

( 7.6)

46.4

( 7.4)

43.4

( 8.3)

South Carolina

39.4

( 9.8)

33.8

( 9.8)

22.7

( 6.0)

31.6

( 5.5)

30.5

( 6.1)

31.3

( 5.8)

34.7

( 8.0)

South Dakota

43.4

(10.9)

49.9

(10.9)

23.3

(10.2)

43.3

( 6.2)

33.0

( 6.8)

46.5

( 6.9)

45.4

( 7.0)

Tennessee

36.3

( 9.0)

38.1

( 9.0)

31.9

( 7.0)

39.5

( 5.2)

34.0

( 5.5)

42.9

( 6.1)

32.8

( 6.5)

Texas

38.8

( 9.9)

48.6

( 9.9)

30.1

( 8.2)

46.6

( 6.9)

34.3

( 6.2)

48.9

( 7.2)

45.0

( 9.2)

Utah

45.2

(10.6)

59.6

(10.6)

37.3

( 6.3)

46.5

( 7.9)

40.9

( 7.8)

52.8

( 8.5)

55.4

( 8.9)

Vermont

44.5

( 8.2)

52.5

( 8.2)

33.6

( 7.6)

42.3

( 5.8)

38.9

( 5.6)

44.0

( 5.9)

49.7

( 7.2)

Virginia

45.3

(10.7)

58.4

(10.7)

41.2

(11.0)

51.7

( 6.8)

43.0

( 6.5)

49.6

( 7.1)

63.5

( 8.5)

Washington

45.9

( 8.3)

56.7

( 8.3)

44.7

( 7.5)

48.3

( 5.6)

45.3

( 5.6)

51.3

( 6.0)

52.6

( 6.7)

West Virginia

32.4

( 8.1)

40.3

( 8.1)

30.2

( 7.9)

38.3

( 5.3)

31.2

( 5.3)

38.7

( 5.6)

39.8

( 7.0)

Wisconsin

53.8

(10.7)

63.6

(10.7)

42.5

( 7.5)

52.1

( 6.9)

48.0

( 7.5)

61.9

( 7.1)

48.2

( 9.2)

Wyoming

43.6

( 9.8)

54.3

( 9.8)

41.4

( 7.1)

56.8

( 6.5)

42.5

( 6.1)

54.3

( 7.0)

58.1

( 8.2)

Median

44.3%

53.3%

37.2%

43.3%

40.3%

48.3%

46.3%

Range

(26.9%-63.7%)

(15.3%-63.9%)

(22.7%-53.9%)

(24.7%-56.8%)

(26.8%-54.0%)

(17.4%-61.9%)

(30.6%-63.5%)

* n = 42,692.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Insufficient number of respondents.


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Table 12

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TABLE 12. Percentage of adults aged >=55 years who reported receiving influenza vaccination during the preceding 12 months, by state and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age group (yrs)

% Point difference from national objectives

 

55-64

65-74

>=65

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

37.7

( 6.1)

57.3

( 6.8)

62.6

( 4.9)

70.9

( 7.1)

2.6

Alaska

50.8

(11.5)

59.6

(13.3)

58.3

(11.4)

54.0

(21.8)

-1.7

Arizona

48.2

( 8.6)

66.5

( 7.6)

72.9

( 5.4)

82.0

( 6.9)

12.9

Arkansas

37.4

( 6.8)

56.5

( 7.1)

61.1

( 5.3)

67.4

( 7.8)

1.1

California

38.2

( 5.2)

64.0

( 5.1)

65.5

( 3.8)

67.6

( 5.6)

5.5

Colorado

54.7

( 7.4)

72.4

( 7.4)

74.4

( 5.5)

78.3

( 7.2)

14.4

Connecticut

36.0

( 8.6)

62.9

( 6.9)

67.2

( 5.1)

73.8

( 7.0)

7.2

Delaware

47.0

( 6.3)

65.2

( 5.4)

68.6

( 4.2)

74.6

( 6.2)

8.6

District of Columbia

31.9

( 7.9)

55.9

( 8.9)

54.3

( 7.1)

51.7

(10.8)

-5.7

Florida

31.4

( 5.0)

62.7

( 4.7)

62.3

( 3.4)

61.8

( 5.2)

2.3

Georgia

28.5

( 6.2)

54.8

( 7.2)

58.5

( 5.8)

66.7

( 9.0)

-1.5

Hawaii

42.7

( 7.9)

68.7

( 6.8)

71.1

( 5.2)

74.8

( 8.0)

11.1

Idaho

39.0

( 6.0)

63.6

( 4.7)

66.4

( 3.5)

70.4

( 5.2)

6.4

Illinois

39.5

( 8.4)

67.4

( 8.0)

67.8

( 6.5)

68.5

( 9.8)

7.8

Indiana

38.3

( 6.3)

60.9

( 6.9)

62.5

( 5.2)

64.9

( 8.1)

2.5

Iowa

42.2

( 4.9)

67.1

( 4.7)

69.7

( 3.4)

72.9

( 4.7)

9.7

Kansas

41.1

( 7.0)

60.4

( 7.0)

61.5

( 5.2)

62.9

( 7.6)

1.5

Kentucky

37.2

( 4.9)

59.9

( 4.9)

61.2

( 3.7)

63.4

( 5.6)

1.2

Louisiana

30.5

( 6.8)

56.7

( 7.9)

58.4

( 6.1)

61.5

(10.3)

-1.6

Maine

35.4

( 7.0)

68.0

( 7.6)

72.1

( 5.4)

77.7

( 7.4)

12.1

Maryland

37.7

( 5.1)

63.7

( 5.3)

63.4

( 4.4)

62.9

( 7.5)

3.4

Massachusetts

37.6

( 8.7)

63.1

( 8.0)

66.0

( 6.0)

70.5

( 8.7)

6.0

Michigan

33.3

( 5.8)

61.3

( 6.9)

63.6

( 5.0)

66.7

( 7.2)

3.6

Minnesota

43.5

( 4.6)

64.9

( 4.7)

69.0

( 3.3)

73.9

( 4.3)

9.0

Mississippi

38.2

( 7.4)

57.4

( 7.4)

61.1

( 5.5)

67.3

( 8.5)

1.1

Missouri

45.8

( 7.2)

68.4

( 6.7)

70.3

( 5.0)

73.1

( 7.6)

10.3

Montana

45.1

( 7.2)

65.6

( 7.4)

68.4

( 5.4)

72.3

( 7.3)

8.4

Nebraska

51.0

( 6.7)

61.0

( 6.0)

65.8

( 4.1)

71.5

( 5.4)

5.8

Nevada

36.7

( 9.0)

48.7

(12.1)

56.5

(10.2)

76.8

(15.1)

-3.5

New Hampshire

35.9

( 8.7)

58.5

( 8.2)

64.6

( 6.2)

74.6

( 8.7)

4.6

New Jersey

34.4

( 6.4)

60.2

( 6.3)

60.7

( 4.8)

61.6

( 7.5)

0.7

New Mexico

33.8

( 7.0)

70.0

( 6.5)

72.8

( 4.9)

77.7

( 7.0)

12.8

New York

32.7

( 5.4)

61.6

( 5.7)

64.5

( 4.2)

68.8

( 6.1)

4.5

North Carolina

35.4

( 4.9)

64.0

( 5.0)

64.6

( 3.8)

65.6

( 5.7)

4.6

North Dakota

34.3

( 7.0)

62.8

( 6.9)

64.8

( 4.8)

67.3

( 6.6)

4.8

Ohio

33.7

( 5.8)

62.2

( 5.3)

65.4

( 4.1)

71.6

( 6.7)

5.4

Oklahoma

47.0

( 7.5)

68.0

( 5.0)

69.3

( 4.2)

73.1

( 7.5)

9.3

Oregon

46.2

( 5.5)

66.5

( 5.6)

69.8

( 4.1)

75.1

( 5.4)

9.8

Pennsylvania

30.1

( 4.8)

62.1

( 5.1)

65.8

( 3.8)

71.5

( 5.6)

5.8

Rhode Island

35.4

( 7.2)

65.8

( 7.1)

67.7

( 5.3)

70.8

( 7.6)

7.7

South Carolina

39.9

( 6.3)

71.3

( 5.4)

74.3

( 4.2)

80.0

( 6.0)

14.3

South Dakota

46.6

( 7.3)

66.6

( 6.3)

65.6

( 4.5)

64.3

( 6.3)

5.6

Tennessee

46.8

( 5.7)

67.6

( 5.5)

69.1

( 4.1)

71.4

( 6.1)

9.1

Texas

38.6

( 6.3)

66.8

( 6.7)

68.0

( 5.2)

70.1

( 8.0)

8.0

Utah

36.2

( 7.3)

58.1

( 8.1)

66.1

( 5.6)

76.3

( 7.2)

6.1

Vermont

40.0

( 5.6)

65.6

( 5.5)

69.5

( 4.1)

75.0

( 5.9)

9.5

Virginia

38.4

( 6.3)

65.2

( 6.2)

67.7

( 4.8)

72.2

( 7.6)

7.7

Washington

40.0

( 5.5)

66.9

( 5.5)

70.2

( 4.0)

74.8

( 5.6)

10.2

West Virginia

37.8

( 5.7)

55.9

( 5.9)

58.2

( 4.4)

62.2

( 6.8)

-1.8

Wisconsin

31.4

( 7.0)

59.8

( 7.2)

66.1

( 5.3)

76.8

( 6.9)

6.1

Wyoming

50.4

( 6.2)

70.5

( 6.4)

72.4

( 4.8)

75.6

( 7.0)

12.4

Median

38.2%

63.6%

66.0%

71.4%

 

Range

(28.5%-54.7%)

(48.7%-72.4%)

(54.3%-74.4%)

(51.7%-82.0%)

 

* n = 41,115.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Healthy People 2000 objective to increase influenza vaccination rates to >= 60% among persons aged >= 65 years.


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Table 13

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TABLE 13. Percentage of adults aged >=55 years who reported ever receiving pneumococcal vaccination, by state and age group -- United States, Behavioral Risk Factor Surveillance System, 1997*

 

Age group (yrs)

% Point difference from national objectives

 

55-64

65-74

>=65

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama

20.3

( 5.0)

45.5

( 6.7)

47.5

( 5.2)

50.6

( 8.4)

-12.5

Alaska

30.7

(10.6)

36.6

(12.6)

39.2

(11.0)

48.1

(21.8)

-20.8

Arizona

20.2

( 6.3)

56.9

( 8.0)

59.4

( 6.1)

63.1

( 8.6)

-0.6

Arkansas

16.2

( 5.3)

33.8

( 7.0)

39.1

( 5.4)

46.1

( 8.3)

-20.9

California

22.7

( 4.7)

44.6

( 5.3)

49.8

( 4.0)

57.8

( 6.0)

-10.2

Colorado

17.8

( 5.7)

50.4

( 7.9)

53.3

( 6.1)

58.9

( 9.1)

-6.7

Connecticut

13.1

( 4.8)

38.6

( 6.8)

43.0

( 5.4)

49.7

( 8.4)

-17.0

Delaware

15.7

( 4.2)

48.4

( 6.1)

52.6

( 4.7)

60.1

( 7.0)

-7.4

District of Columbia

16.0

( 6.3)

30.4

( 8.3)

32.3

( 6.7)

35.4

(10.7)

-27.7

Florida

15.1

( 4.1)

42.6

( 4.7)

45.5

( 3.5)

49.2

( 5.2)

-14.5

Georgia

18.4

( 5.3)

43.3

( 7.2)

48.5

( 5.7)

60.0

( 9.2)

-11.5

Hawaii

20.3

( 6.5)

47.1

( 7.7)

51.7

( 5.9)

59.2

( 9.4)

-8.3

Idaho

16.4

( 3.5)

44.3

( 5.0)

50.2

( 3.8)

58.6

( 5.5)

-9.8

Illinois

17.2

( 6.3)

46.7

( 8.2)

44.7

( 6.6)

40.8

(10.5)

-15.3

Indiana

12.4

( 4.1)

36.2

( 7.1)

38.0

( 5.4)

40.7

( 8.1)

-22.0

Iowa

19.1

( 3.9)

44.9

( 5.3)

51.5

( 3.9)

59.4

( 5.4)

-8.5

Kansas

17.1

( 5.4)

37.8

( 7.0)

43.7

( 5.3)

52.2

( 7.8)

-16.3

Kentucky

14.1

( 3.4)

37.7

( 5.0)

38.6

( 3.7)

40.1

( 5.4)

-21.4

Louisiana

19.1

( 6.7)

32.7

( 7.4)

32.2

( 5.8)

31.4

( 9.4)

-27.8

Maine

21.7

( 6.8)

45.3

( 7.5)

50.0

( 5.7)

56.7

( 8.8)

-10.0

Maryland

10.8

( 3.1)

38.1

( 5.5)

41.0

( 4.4)

46.6

( 7.1)

-19.0

Massachusetts

14.2

( 6.4)

46.0

( 8.3)

52.7

( 6.3)

62.9

( 9.1)

-7.3

Michigan

12.7

( 4.0)

41.6

( 7.0)

45.6

( 5.2)

51.0

( 7.7)

-14.4

Minnesota

18.9

( 3.5)

43.3

( 4.9)

48.3

( 3.5)

54.4

( 5.0)

-11.7

Mississippi

25.8

( 7.2)

41.3

( 7.7)

45.9

( 6.0)

53.7

( 9.4)

-14.1

Missouri

17.8

( 5.8)

41.3

( 7.2)

44.3

( 5.7)

48.8

( 8.7)

-15.7

Montana

18.4

( 5.5)

44.0

( 7.7)

50.8

( 5.9)

60.5

( 7.9)

-9.2

Nebraska

20.7

( 6.0)

46.1

( 6.3)

49.8

( 4.4)

54.2

( 6.0)

-10.2

Nevada

24.0

( 8.3)

43.5

(11.8)

53.5

(10.4)

79.0

(12.0)

-6.5

New Hampshire

13.9

( 6.1)

44.5

( 8.2)

49.6

( 6.5)

58.8

(10.2)

-10.4

New Jersey

10.8

( 4.0)

30.1

( 5.8)

33.9

( 4.6)

40.4

( 7.6)

-26.1

New Mexico

11.2

( 4.4)

49.4

( 7.0)

50.1

( 5.7)

51.3

( 9.6)

-9.9

New York

9.5

( 3.2)

37.1

( 5.9)

38.9

( 4.5)

41.9

( 6.8)

-21.1

North Carolina

19.7

( 4.4)

48.2

( 5.1)

50.6

( 3.9)

55.4

( 6.1)

-9.4

North Dakota

17.0

( 5.7)

36.6

( 6.6)

40.8

( 4.8)

46.2

( 7.1)

-19.2

Ohio

13.6

( 4.3)

33.4

( 5.5)

38.5

( 4.5)

48.9

( 7.4)

-21.5

Oklahoma

24.3

( 6.7)

34.6

( 5.0)

40.4

( 4.3)

56.2

( 7.8)

-19.6

Oregon

17.6

( 4.5)

52.2

( 5.8)

55.9

( 4.3)

61.7

( 6.3)

-4.1

Pennsylvania

14.4

( 3.9)

42.3

( 5.3)

47.1

( 4.1)

54.6

( 6.7)

-12.9

Rhode Island

13.1

( 5.2)

36.5

( 7.2)

43.0

( 5.6)

53.3

( 8.6)

-17.0

South Carolina

14.8

( 4.7)

37.7

( 6.1)

41.6

( 4.8)

48.8

( 7.9)

-18.4

South Dakota

18.7

( 5.2)

39.5

( 6.3)

40.6

( 4.5)

42.2

( 6.4)

-19.4

Tennessee

15.6

( 4.2)

44.8

( 6.1)

45.0

( 4.5)

45.4

( 6.5)

-15.0

Texas

15.7

( 4.7)

42.0

( 7.1)

44.4

( 5.6)

48.5

( 9.2)

-15.6

Utah

18.1

( 6.0)

41.5

( 8.3)

48.5

( 6.2)

57.6

( 8.8)

-11.5

Vermont

16.9

( 4.3)

47.9

( 5.9)

51.6

( 4.5)

56.9

( 7.0)

-8.4

Virginia

18.2

( 5.6)

48.4

( 7.2)

53.6

( 5.6)

63.0

( 8.7)

-6.4

Washington

15.3

( 4.1)

46.5

( 5.9)

51.6

( 4.5)

58.5

( 6.7)

-8.4

West Virginia

21.4

( 4.7)

35.8

( 5.5)

41.3

( 4.4)

51.2

( 6.8)

-18.7

Wisconsin

14.1

( 5.0)

39.1

( 7.3)

42.6

( 5.7)

48.6

( 9.3)

-17.4

Wyoming

22.1

( 5.1)

45.2

( 7.0)

50.9

( 5.4)

60.2

( 8.1)

-9.1

Median

17.1%

42.6%

45.9%

53.3%

 

Range

(9.5%-30.7%)

(30.1%-56.9%)

(32.2%-59.4%)

(31.4%-79.0%)

 

* n = 40,137.
† Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Healthy People 2000 objective to increase pneumococcal vaccination rates to >= 60% among persons aged >= 65 years.


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Table 14

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TABLE 14. Percentage of adults aged >=55 years who reported a dental visit during the preceding 12 months, by state and age group -- United States, Behavioral Risk Factor Surveillance System (BRFSS), 1995-1997*

 

Age group (yrs)

 

55-64

>=65

65-74

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama††

61.7

( 4.9)

50.4

( 4.1)

50.8

( 5.1)

49.6

( 6.5)

Alaska

61.7

(12.5)

75.0

(10.1)

79.4

(10.6)

58.1

(20.0)

Arizona**

67.5

( 5.9)

67.6

( 4.2)

69.3

( 5.3)

65.0

( 6.5)

Arkansas

59.6

( 6.7)

47.6

( 5.5)

54.1

( 7.3)

37.5

( 7.8)

California††

70.5

( 3.7)

68.1

( 2.9)

68.7

( 3.7)

67.0

( 4.3)

Colorado††

67.0

( 7.4)

65.6

( 5.9)

69.4

( 7.6)

58.2

( 9.2)

Connecticut**

76.6

( 6.9)

69.1

( 5.6)

69.6

( 7.4)

68.4

( 8.6)

Florida††

70.2

( 5.1)

65.8

( 3.3)

68.2

( 4.3)

62.7

( 5.1)

Georgia

59.9

( 7.6)

49.7

( 5.1)

49.7

( 5.9)

49.8

(10.2)

Hawaii**

86.5

( 5.5)

75.4

( 5.4)

75.3

( 6.7)

75.6

( 9.0)

Idaho††

65.9

( 3.7)

59.1

( 2.9)

61.8

( 3.7)

55.3

( 4.5)

Illinois**

71.2

( 5.5)

61.0

( 4.7)

61.4

( 6.1)

60.3

( 7.6)

Indiana**††

61.0

( 3.7)

52.8

( 3.0)

54.8

( 3.9)

49.8

( 4.5)

Iowa

67.3

( 5.1)

61.0

( 3.8)

62.8

( 5.3)

58.7

( 5.7)

Kansas**

68.5

( 7.4)

56.8

( 5.1)

63.6

( 6.9)

47.8

( 7.6)

Kentucky**

57.1

( 7.3)

41.2

( 5.3)

44.3

( 6.9)

35.9

( 7.8)

Louisiana**

50.4

( 7.8)

47.2

( 6.0)

50.8

( 7.4)

40.1

( 9.0)

Maine

56.5

( 8.0)

47.7

( 6.4)

50.5

( 8.0)

43.1

( 9.8)

Maryland††

67.7

( 7.3)

62.0

( 6.2)

60.9

( 7.6)

63.9

(10.6)

Massachusetts

73.3

( 7.1)

58.9

( 6.0)

63.8

( 7.4)

49.3

( 9.8)

Michigan**

76.4

( 5.5)

63.9

( 5.3)

63.2

( 6.7)

65.2

( 8.4)

Mississippi††

51.8

( 7.8)

50.1

( 6.1)

55.1

( 8.0)

42.1

( 9.4)

Missouri††

58.7

( 6.9)

58.7

( 5.4)

60.2

( 7.1)

56.3

( 8.4)

Montana**††

65.0

( 4.5)

61.1

( 3.3)

64.1

( 4.3)

56.8

( 5.1)

Nebraska**

67.1

( 6.5)

62.5

( 3.5)

65.9

( 6.1)

57.2

( 6.9)

Nevada**††

58.8

( 6.9)

58.0

( 6.6)

57.0

( 7.8)

61.2

(11.6)

New Hampshire**

70.4

( 7.8)

63.9

( 6.3)

67.9

( 7.6)

55.9

(10.4)

New Jersey**††

71.2

( 4.3)

65.5

( 3.2)

67.0

( 4.3)

62.8

( 5.1)

New Mexico††

69.9

( 6.7)

64.0

( 5.3)

65.7

( 6.9)

61.1

( 9.0)

New York††

73.2

( 4.1)

62.5

( 3.5)

65.7

( 4.3)

57.1

( 5.5)

North Dakota

71.8

( 7.3)

55.8

( 5.0)

63.2

( 6.7)

44.8

( 7.1)

Ohio††

70.0

( 5.1)

57.8

( 3.8)

60.6

( 4.9)

52.8

( 6.5)

Oklahoma**

62.5

( 7.3)

39.7

( 4.4)

40.3

( 5.5)

38.4

( 6.9)

Oregon

69.1

( 5.9)

66.7

( 4.1)

68.5

( 5.3)

63.6

( 6.7)

Pennsylvania**

65.8

( 5.1)

57.2

( 3.9)

61.1

( 4.9)

49.0

( 6.7)

Rhode Island

69.6

( 6.9)

55.5

( 5.7)

57.9

( 7.6)

51.8

( 8.6)

South Dakota**

74.2

( 6.1)

54.3

( 4.3)

56.7

( 6.5)

51.2

( 6.5)

Tennessee††

62.0

( 5.5)

52.1

( 4.8)

56.9

( 6.1)

44.8

( 7.3)

Texas**

64.2

( 5.7)

57.2

( 4.8)

58.5

( 5.9)

54.8

( 7.8)

Utah**††

73.9

( 3.7)

63.2

( 3.2)

66.0

( 4.1)

59.4

( 4.9)

Vermont

67.5

( 5.9)

57.7

( 5.0)

59.8

( 6.5)

54.4

( 6.5)

Virginia**††

68.4

( 3.9)

63.5

( 3.6)

65.9

( 4.3)

58.6

( 6.3)

Washington

70.1

( 4.9)

63.3

( 4.8)

65.1

( 6.5)

60.2

( 7.1)

West Virginia††

47.4

( 5.9)

43.4

( 4.5)

46.0

( 5.9)

38.9

( 6.9)

Wisconsin

74.1

( 6.7)

72.1

( 5.0)

76.8

( 6.3)

64.3

( 8.4)

Wyoming

62.6

( 6.3)

59.1

( 5.2)

66.1

( 6.3)

46.6

( 8.4)

Median

67.5%

59.1%

63.0%

56.1%

Range

(47.4%-86.5%)

(39.7%-75.4%)

(40.3%-79.4%)

(35.9%-75.6%)

* n = 44,872.
† For states in which data were collected during 1 year, analysis was conducted by merging data for multiple years. Data are presented for the 46 states that had administered the BRFSS Oral Health Module at least once during 1995-1997.
Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Data from 1995 BRFSS.
** Data from 1996 BRFSS.
†† Data from 1997 BRFSS.


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Table 15

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TABLE 15. Percentage of adults aged >=55 years who reported having no dental insurance, by state and age group -- United States, Behavioral Risk Factor Surveillance System (BRFSS), 1995-1997*

Age group (yrs)

 

55-64

>=65

65-74

>=75

State

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Alabama††

55.0

( 5.1)

73.0

( 3.6)

70.9

( 4.7)

77.0

( 5.5)

Alaska

41.8

(12.3)

50.8

(15.9)

45.3

(18.8)

73.7

(15.1)

Arizona **

42.5

( 5.9)

57.5

( 4.4)

57.2

( 5.9)

58.0

( 6.5)

Arkansas

62.3

( 7.1)

83.9

( 4.1)

84.2

( 4.9)

83.5

( 6.1)

California††

44.8

( 3.9)

50.3

( 3.1)

44.7

( 4.1)

59.1

( 4.7)

Colorado††

44.5

( 7.6)

67.8

( 5.9)

67.3

( 7.6)

68.9

( 8.8)

Connecticut**

32.7

( 7.4)

71.7

( 5.5)

62.7

( 8.0)

84.8

( 6.5)

Florida††

58.7

( 5.5)

63.8

( 3.4)

59.0

( 4.7)

70.0

( 4.7)

Georgia

48.6

( 7.6)

61.7

( 4.9)

58.1

( 5.7)

73.7

( 9.0)

Hawaii**

18.4

( 5.7)

41.3

( 5.9)

36.5

( 6.9)

50.6

(10.6)

Idaho††

48.7

( 4.1)

81.9

( 2.3)

80.6

( 3.1)

83.7

( 3.3)

Illinois**††

48.9

( 6.1)

71.9

( 4.6)

71.7

( 6.1)

72.2

( 7.1)

Indiana**††

47.2

( 3.7)

73.0

( 2.7)

69.1

( 3.7)

78.8

( 3.7)

Iowa

47.5

( 5.5)

80.6

( 2.9)

80.0

( 4.1)

81.6

( 4.1)

Kansas**

42.7

( 7.8)

68.8

( 4.7)

66.1

( 6.5)

72.6

( 6.7)

Kentucky**

58.0

( 7.6)

86.5

( 3.6)

83.2

( 4.9)

92.1

( 4.3)

Louisiana**

62.8

( 8.2)

81.7

( 4.5)

78.5

( 6.1)

87.7

( 5.5)

Maine

67.2

( 7.8)

84.0

( 4.6)

80.8

( 6.5)

89.2

( 6.1)

Maryland††

42.1

( 7.8)

58.6

( 6.2)

51.6

( 7.6)

70.6

( 9.2)

Massachusetts

51.2

( 8.0)

80.5

( 4.8)

79.7

( 6.1)

82.1

( 7.6)

Michigan**

29.8

( 5.7)

53.7

( 5.6)

49.8

( 7.3)

61.1

( 9.0)

Mississippi††

62.0

( 7.1)

81.2

( 4.8)

80.2

( 6.3)

83.1

( 7.4)

Missouri††

53.7

( 6.9)

76.8

( 4.5)

72.1

( 6.5)

84.1

( 5.5)

Montana**††

55.3

( 4.7)

82.7

( 2.5)

83.3

( 3.1)

81.9

( 4.1)

Nebraska**

55.4

( 6.9)

82.6

( 3.7)

78.1

( 5.5)

89.5

( 4.3)

Nevada**††

38.1

( 6.5)

55.1

( 6.8)

52.1

( 7.8)

64.2

(12.3)

New Hampshire**

52.7

( 9.2)

78.9

( 5.4)

78.0

( 6.7)

80.7

( 9.0)

New Jersey**††

41.6

( 4.5)

67.9

( 3.2)

63.8

( 4.3)

75.2

( 4.7)

New Mexico††

45.8

( 7.1)

67.9

( 5.7)

68.3

( 7.3)

67.1

( 9.4)

New York**††

45.1

( 4.5)

66.9

( 3.5)

63.8

( 4.5)

72.3

( 5.1)

North Dakota

65.2

( 7.8)

87.7

( 3.2)

87.0

( 4.5)

88.7

( 4.5)

Ohio††

47.0

( 5.5)

73.9

( 3.5)

72.6

( 4.3)

76.3

( 6.1)

Oklahoma**

57.6

( 7.1)

81.9

( 3.4)

80.7

( 4.3)

84.7

( 5.3)

Oregon

36.5

( 5.9)

73.7

( 4.0)

69.7

( 5.5)

80.8

( 5.7)

Pennsylvania**

44.9

( 5.3)

70.8

( 3.7)

68.5

( 4.7)

75.9

( 5.7)

Rhode Island

42.1

( 7.4)

76.8

( 5.0)

73.7

( 6.9)

81.6

( 6.9)

South Dakota**

58.7

( 6.7)

88.1

( 3.3)

84.6

( 5.1)

92.4

( 3.5)

Tennessee††

56.2

( 5.9)

81.6

( 3.6)

81.4

( 4.7)

81.9

( 5.7)

Texas**

57.9

( 6.1)

72.6

( 4.4)

72.6

( 5.5)

72.6

( 7.1)

Utah**††

40.7

( 4.1)

71.0

( 3.1)

66.0

( 4.3)

77.6

( 4.1)

Vermont

51.7

( 6.5)

78.6

( 4.1)

75.1

( 5.7)

84.5

( 5.5)

Virginia**††

45.9

( 4.3)

73.0

( 3.4)

71.2

( 4.3)

76.6

( 5.5)

Washington

46.2

( 5.5)

77.6

( 4.2)

76.9

( 5.5)

78.8

( 6.1)

West Virginia††

70.3

( 5.3)

86.2

( 3.1)

84.7

( 4.1)

89.0

( 4.5)

Wisconsin

38.2

( 7.4)

81.4

( 4.6)

79.4

( 6.3)

84.9

( 6.1)

Wyoming

53.3

( 6.3)

76.4

( 4.4)

71.5

( 6.1)

85.2

( 5.7)

Median

48.1%

73.8%

71.9%

79.8%

Range

(18.4%-70.3%)

(41.3%-88.1%)

(36.5%-87.0%)

(50.6%-92.4%)

* n = 44,872.
† For states in which data were collected during 1 year, analysis was conducted by merging data for multiple years. Data are presented for the 46 states that had administered the BRFSS Oral Health Module at least once during 1995-1997.
Confidence interval. CIs were calculated by multiplying the standard error by 1.96.
Data from 1995 BRFSS.
** Data from 1996 BRFSS.
†† Data from 1997 BRFSS.


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