NCHS Data Brief ■ No. 274 ■ March 2017

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Utilization of Clinical Preventive Services for Cancer and 

Heart Disease Among Insured Adults: United States, 2015

Anjel Vahratian, Ph.D. and Stephen J. Blumberg, Ph.D.

Key findings 

Data from the National 

Health Interview Survey

● Two-thirds of insured adults 

aged 50–75 were screened for 

colorectal cancer within the 

recommended intervals.

● Insured women aged 30–39 

(90.5%) were more likely than 

their older peers to be screened 

for cervical cancer within the 

recommended intervals.

● Seventy-three percent of 

insured women aged 50–74 had 

a mammogram in the past 2 

years.

● The percentage of insured 

adults who had a cardiovascular 

risk screening (blood 

pressure, blood sugar) within 

the recommended intervals 

significantly increased with 

advancing age for both men 

and women.

Recent improvements in health insurance coverage (1) have been associated 

with improved access to health care (2–4) and increased utilization of 

preventive services (5). Most insurance plans are now required to cover 

specific clinical preventive services without copayment from the insured adult 

(6). This report presents the proportion of insured adults who received selected 

services that are recommended for the prevention or early detection of cancer 

and heart disease. Sex- and age-specific differences are examined. The age 

groups included in each chart vary because the selected preventive services are 

recommended for different age groups.

Keywords: diabetes • hypertension • National Health Interview Survey

More than 6 out of 10 insured adults aged 50–75 had been 

screened for colorectal cancer within the recommended 

intervals.

Figure 1. Percentage of insured adults aged 50–75 who had any colorectal cancer screening test 

within the recommended intervals, by sex and age group: United States, 2015 

NOTES: Significant quadratic increase by age for both sexes (p < 0.05). Significant sex differences noted for age group 50–59. 

See “Definitions” for more information about the recommended intervals for this screening test. Access data table for Figure 1 at: 

https://www.cdc.gov/nchs/data/databriefs/db274_table.pdf#1.

SOURCE: NCHS, National Health Interview Survey, 2015.

 
NCHS Data Brief ■ No. 274 ■ March 2017

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● The percentage of insured adults who had any colorectal cancer screening test was 

significantly associated with age for both men and women (Figure 1).

● Insured women aged 50–59 (58.1%) were more likely to be screened for colorectal cancer 

compared with men of the same age (54.0%).

● Men and women aged 60 and over were similarly likely to be screened for colorectal cancer 

within the recommended intervals.

More than 8 out of 10 insured women aged 21–65 had been screened for 

cervical cancer within the recommended intervals.

● After age 30–39, receipt of screening within the recommended intervals declined (Figure 2). 

● Insured women aged 21–29 and 60–65 had similar percentages of those screened for 

cervical cancer within the recommended intervals.

Figure 2. Percentage of insured women aged 21–65 who have not had a hysterectomy and had a cervical cancer 

screening test within the recommended intervals, by age group: United States, 2015

NOTES: Significant differences by age when comparing women aged 21–29 with those aged 30–39, 40–49, and 50–59. Significant linear decrease by age after 

age 30–39. See “Definitions” for more information about the recommended intervals for this screening test. Access data table for Figure 2 at: https://www.cdc.gov/

nchs/data/databriefs/db274_table.pdf#2.

SOURCE: NCHS, National Health Interview Survey, 2015. 
NCHS Data Brief ■ No. 274 ■ March 2017

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Nearly three out of four insured women aged 50–74 had been screened for 

breast cancer in the past 2 years.

● The percentage of insured women who had a mammogram in the past 2 years to screen for 

breast cancer ranged from 72.1% for women aged 70–74 to 74.2% for women aged 60–69 

(Figure 3).

● The percentage of insured women who had a mammogram in the past 2 years was similar 

across age groups.

Figure 3. Percentage of insured women aged 50–74 who had a mammogram in the past 2 years, by age group: 

United States, 2015

NOTE: Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db274_table.pdf#3.

SOURCE: NCHS, National Health Interview Survey, 2015. 
NCHS Data Brief ■ No. 274 ■ March 2017

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More than 8 in 10 insured adults aged 18 and over had their blood pressure 

checked by a doctor, nurse, or other health professional in the past 12 

months.

● The percentage of insured adults who had their blood pressure checked by a doctor, nurse, 

or other health professional in the past 12 months increased with advancing age (Figure 4).

● Insured women aged 18–39 (86.7%) and 40–64 (91.7%) were more likely than men in the 

same age groups (70.4% and 86.1%, respectively) to have their blood pressure checked by a 

doctor, nurse, or other health professional in the past 12 months.

● No significant differences by sex were observed among insured adults after age 64.

Figure 4. Percentage of insured adults aged 18 and over who had their blood pressure checked by a doctor, nurse, or 

other health professional in the past 12 months, by sex and age group: United States, 2015

NOTES: Significant linear increase by age for both sexes (p < 0.05). Significant sex differences noted overall and for adults aged 18–39 and 40–64 (p < 0.05). 

Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db274_pdf#4.

SOURCE: NCHS, National Health Interview Survey, 2015.

 
NCHS Data Brief ■ No. 274 ■ March 2017

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About two out of three overweight and obese insured adults aged 40–70 

had a fasting blood test for high blood sugar or diabetes in the past 12 

months.

● The percentage of insured overweight and obese adults who had a fasting blood test for high 

blood sugar or diabetes in the past 12 months increased with advancing age (Figure 5).

● Insured women aged 40–49 (56.4%) were more likely than men in the same age group 

(49.5%) to have had a fasting blood test for high blood sugar or diabetes in the past 12 

months.

● No significant differences by sex were observed among insured adults aged 50–70.

Figure 5. Percentage of overweight and obese insured adults aged 40–70 who had a fasting test for high blood sugar or 

diabetes during the past 12 months, by sex and age group: United States, 2015 

NOTES: Significant linear increase by age for both sexes (p < 0.05). Significant sex differences noted overall and for adults aged 40–49 (p < 0.05). Access data 

table for Figure 5 at: https://www.cdc.gov/nchs/data/databriefs/db274_table.pdf#5.

SOURCE: NCHS, National Health Interview Survey, 2015.

 

Summary

Utilization of clinical preventive services aimed at the early detection of cancer and 

cardiovascular disease varied by sex and age among insured adults. In this analysis, insured adults 

in their 40s and 50s were less likely than those in their 60s to be screened for colorectal cancer, 

high blood pressure, and diabetes. Limited knowledge about the recommendations for clinical 

preventive services may prevent eligible adults from seeking timely preventive care (7,8).

Younger insured women were more likely than men of the same age to have had a colorectal 

cancer screening test within the recommended intervals and their blood pressure and blood sugar 

checked in the past 12 months. These sex-specific differences may be due, in part, to women’s 

increased and earlier utilization of health care for reproductive health services (9–11). 
NCHS Data Brief ■ No. 274 ■ March 2017

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Lastly, insured women aged 40–65 were less likely to be screened for cervical cancer within the 

recommended intervals compared with those aged 30–39, while no significant differences were 

seen in breast cancer screening by age for those aged 50–74. The findings in this report highlight 

areas for further research and targeted health promotion.

Definitions

The recommended intervals for the clinical preventive services included in this report are drawn 

from the U.S. Preventive Services Task Force (USPSTF) guidelines (12). Most health insurance 

plans are required to cover specific clinical preventive services, including those that have received 

an A or B rating from the USPSTF, without requiring the insured person to pay a portion of the 

costs (6).

Blood pressure screening: Based on a positive response to the survey question, “During the 

past 12 months, have you had your blood pressure checked by a doctor, nurse, or other health 

professional?” The 2015 USPSTF recommends screening for high blood pressure or hypertension 

in adults aged 18 and over (12).

Breast cancer screening: Based on the 2009 USPSTF recommendation that women aged 50–74 

have a mammogram every 2 years (12).

Cervical cancer screening: Based on the 2012 USPSTF recommendation that women aged 21–65 

without a prior hysterectomy have a Pap smear every 3 years or for women aged 30–65 who 

want to lengthen the screening interval, screening with a combination of a Pap smear and human 

papillomavirus (HPV) testing every 5 years (12).

Colorectal cancer screening: Based on the 2008 USPSTF recommendation that adults aged 

50–75 have either a colonoscopy within the past 10 years, a sigmoidoscopy within the past 

5 years combined with a home blood stool test every 3 years, or a home blood stool or fecal 

immunochemical test within the past year (12).

Diabetes screening: Based on a positive response to the survey question, “Have you had a fasting 

test for high blood sugar or diabetes during the past 12 months?” The 2015 USPSTF recommends 

screening for high blood sugar or diabetes as part of a cardiovascular risk assessment in adults 

aged 40–70 who are overweight and obese (12).

Health insurance coverage: Insured adults included those who, at the time of interview, had 

any private health insurance, Medicare, Medicaid, Children’s Health Insurance Program, a 

state-sponsored or other government health plan, or a military plan.

Overweight and obesity: Based on cut points of body mass index (BMI). BMI was calculated 

as reported weight in kilograms divided by reported height in meters squared. Overweight and 

obesity in adults was defined as a BMI of equal to or greater than 25.
NCHS Data Brief ■ No. 274 ■ March 2017

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Data source and methods

Data from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS 

is a multipurpose health survey conducted continuously throughout the year by the National 

Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but 

follow-ups to complete interviews may be conducted over the telephone. Data for this analysis 

came from the Family Core and Sample Adult components of NHIS. For further information 

about NHIS, including the questionnaire, visit the NHIS website at: https://www.cdc.gov/nchs/

nhis.htm. 

All analyses used weights to produce national estimates. Estimates on clinical preventive services 

in this report are nationally representative of the civilian noninstitutionalized adult population 

living in households across the United States. The sample design is described in more detail 

elsewhere (13). Point estimates and their estimated variances were calculated using SUDAAN 

software (14) to account for the complex sample design of NHIS. Linear and quadratic trend 

tests of the estimated proportions across the age groups were tested in SUDAAN via PROC 

DESCRIPT using the POLY option. Differences between percentages were evaluated using 

two-sided significance tests at the 0.05 level.

About the authors

Anjel Vahratian and Stephen J. Blumberg are with the National Center for Health Statistics, 

Division of Health Interview Statistics.

References

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from the National Health Interview Survey, 2015. National Center for Health Statistics. May 

2016. Available from: https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201605.pdf.

2. Martinez ME, Ward BW, Adams PF. Health care access and utilization among adults aged 

18–64, by race and Hispanic origin: United States, 2013 and 2014. NCHS data brief, no 208. 

Hyattsville, MD: National Center for Health Statistics. 2015. Available from: https://www.cdc.

gov/nchs/data/databriefs/db208.pdf.

3. Martinez ME, Ward BW. Health care access and utilization among adults aged 18–64, by 

poverty level: United States, 2013–2015. NCHS data brief, no 262. Hyattsville, MD: National 

Center for Health Statistics. 2016. Available from: https://www.cdc.gov/nchs/data/databriefs/

db262.pdf.

4. Sommers BD, Blendon RJ, Orav EJ, Epstein AM. Changes in utilization and health among 

low-income adults after Medicaid expansion or expanded private insurance. JAMA Intern Med 

176(10):1501–9. 2016.

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preventive care under the Affordable Care Act. N Engl J Med 371(24):2341–2. 2014.

6. Koh HK, Sebelius KG. Promoting prevention through the Affordable Care Act. N Engl J Med 

363(14):1296–9. 2010.
NCHS Data Brief ■ No. 274 ■ March 2017

7. Lantz PM, Evans WD, Mead H, Alvarez C, Stewart L. Knowledge of and 

attitudes toward evidence-based guidelines for and against clinical preventive 

services: Results from a national survey. Milbank Q 94(1):51–76. 2016.

8. Koh HK, Rajkumar R, McDonough JE. Reframing prevention in the era 

of health reform. JAMA 316(10):1039–40. 2016.

9. Vahratian A. QuickStats: Percentage of adults aged ≥ 18 who have 

seen or talked to a doctor or other health care professional about their 

own health in the past 12 months, by sex and age group—National Health 

Interview Survey, United States, 2015. MMWR Morb Mortal Wkly Rep 

66(02):65. 2017. Available from: https://www.cdc.gov/mmwr/volumes/66/

wr/mm6602a12.htm?s_cid=mm6602a12_w.

10. Martinez GM, Chandra A, Febo-Vazquez I, Mosher WD. Use of family 

planning and related medical services among women aged 15–44 in the 

United States: National Survey of Family Growth, 2006–2010. National 

health statistics reports; no 68. Hyattsville, MD: National Center for Health 

Statistics. 2013.

11. Hing E, Albert M. State variation in preventive care visits, by patient 

characteristics, 2012. NCHS data brief, no 234. Hyattsville, MD: National 

Center for Health Statistics. 2016.

12. U.S. Preventive Services Task Force. USPSTF A and B 

recommendations. 2017. Available from: https://www.uspreventiveservices

taskforce.org/Page/Name/uspstf-a-and-b-recommendations/.

13. Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the 

National Health Interview Survey, 2006–2015. National Center for Health 

Statistics. Vital Health Stat 2(165). 2014. Available from: https://www.cdc.

gov/nchs/data/series/sr_02/sr02_165.pdf.

14. RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citation

Vahratian A, Blumberg SJ. Utilization of 

clinical preventive services for cancer and 

heart disease among insured adults: United 

States, 2015. NCHS data brief, no 274. 

Hyattsville, MD: National Center for Health 

Statistics. 2017.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview Statistics

Marcie L. Cynamon, Director

Stephen J. Blumberg, Ph.D., Associate 

Director for Science

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