Preventive Care Service Usage Among Chinese Older Adults in the Greater Chicago Area

Preventive care such as immunization and cancer screenings has been increasingly recognized for its importance in reducing morbidity and mortality among older adults in the United States. Elderly populations are vulnerable to influenza-related complications and invasive pneumococcal infection. In 2010, influenza and pneumonia caused approximately 43,000 deaths among people aged 65 and older (1). Because influenza and pneumococcal vaccination remain the most effective ways to prevent and control influenza and pneumonia, annual flu shots and one-time pneumonia shots have been recommended nationwide. With cancer ranked as the second leading cause of death for people aged 65 and older (1), early detection is important. Cancer screening tests have proven efficacy in detecting colon cancer, breast cancer, and cervical cancer at an early stage when chances of treatment and survival are highest. To improve public health and promote utilization of preventive care services, Healthy People 2020 (2) established long-term objectives for immunization and cancer screening, with a target increase from 66.6% to 90% for flu vaccination and increase from 60.1% to 90% for pneumonia vaccination among people aged 65 and older. Healthy People 2020 (2) cancer screening goals include participation rates of 70.5% for colon cancer screening, 81.1% for breast cancer screening, 93% for cervical cancer screening, and 15.9% for discussion with health providers about the prostate-specific antigen (PSA) test for prostate cancer. Although preventive care utilization has greatly increased over the years, strong evidence indicates that preventive care utilization remains relatively low among ethnic minority groups, including Asian Americans. For example, among older adults aged 65 and older, Asian Americans had significant lower utilization of screening mammography than whites (3). Common barriers for use preventive care services among ethnic minority groups include lower socioeconomic status, lack of insurance, poor access to health service providers, and lack of physician recommendation (4,5). In addition, barriers more unique to Asian Americans relate to traditional beliefs and cultural heritage—such as Eastern approaches to medicine and using health care services only when symptomatic (6,7). Although the Chinese community is the largest Asian American subgroup population, systematic studies focusing on Chinese Americans are still scarce. To date, despite the heterogeneity of Asian American subgroup with respect to culture, immigration history, and socioeconomic status, research studies generally pool Asian Americans together when comparing different racial groups. Some prior studies of preventive service utilization have focused on different Asian American subgroups, such as Chinese, Japanese, Korean, and Vietnam Americans—but these studies tend to focus on only one specific preventive care service. To bridge these knowledge gaps, the objectives of this study are to: (i) study the utilization of immunization and cancer screening services among community dwelling Chinese older adults in the Greater Chicago area; and (ii) assess the extent to which sociodemographic characteristics and self-reported health and quality of life factors are associated with preventive care service use.