Patient-Clinician Sex and Race and/or Ethnicity Concordance and Adherence to Preventive Services Guidelines: MEPS 2018-2020

Abstract

Abstract Background Patient-clinician sex, racial, and ethnic concordance have been shown to improve healthcare utilization, but the impact of each on adherence to preventive services guidelines among specific populations remains unclear. Objective To estimate the association between patient-clinician sex and racial and/or ethnic concordance and adherence to preventive services guidelines. Design Cross-sectional study using nationally representative data from the Medical Expenditure Panel Survey (2018, 2020). Participants Adults �� 18 years old who reported having a usual healthcare clinician. Adults who identified as multiracial, identified their clinician as being multiracial, or who did not report clinician sex, race, or ethnicity were excluded. Main Measures Adherence to preventive services guidelines for influenza, pneumococcal, and shingles vaccines; breast, cervical, and colorectal cancer screening; and blood pressure and cholesterol screening. Predicted marginal prevalences and prevalence ratios were estimated using multivariable logistic regression, adjusting for sociodemographics, chronic conditions, and self-reported health status. Key Results Females were less likely to report sex concordance compared to males (52.5% vs. 69.8%, p < 0.01). Among females, sex concordance increased influenza (PR = 1.08, 95% CI = 1.04-1.12), pneumococcal (PR = 1.06, 95% CI = 1.02-1.11), and shingles (PR = 1.09, 95% CI = 1.01-1.17) vaccination, as well as breast (PR = 1.06, 95% CI = 1.01-1.10), cervical (PR = 1.09, 95% CI = 1.05-1.13), and colorectal (PR = 1.07, 95% CI = 1.03-1.10) cancer screening, but not among males. Racial and/or ethnic concordance was low among American Indian and Alaska Native, Black, Latino, and Native Hawaiian and Pacific Islander patients (< 25%) and was not associated with adherence in preventive services. Conclusions Females with female clinicians are more likely to adhere to preventive services guidelines. Racial and/or ethnic concordance was not associated with adherence to preventive services guidelines, but racial and/or ethnic concordance was low among non-White patients. Sex and racial and/or ethnic concordance may be a powerful tool for increasing preventive services utilization, but increased racial and/or ethnic concordance is needed to reach more definitive conclusions.