Explaining racial and ethnic disparities in cholesterol screening

• There are large racial and ethnic differences in cholesterol screening rates.
• 9.1% of eligible 2011 BRFSS respondents reported never having been screened.
• This reflects 13 million Americans with Blacks and Hispanics overrepresented.
• Socioeconomic status, care access and Spanish language explained most disparities.
• Expanding insurance coverage and simplifying risk assessment may improve screening.

ObjectiveTo determine whether racial and ethnic disparities in cholesterol screening persist after controlling for socioeconomic status, access to care and language.MethodsData were obtained from the 2011 Behavioral Risk Factor Surveillance System for men aged 35 and older and women aged 45 and older in accordance with the United States Preventive Services Task Force guidelines. Self-reported cholesterol screening data are presented for 389,039 respondents reflecting over 141 million people. Sequential logistic regression models of the likelihood of never having been screened are presented adjusted for demographic characteristics, health status, behavioral risk factors, socioeconomic status, health care access, and questionnaire language.ResultsA total of 9.1% of respondents, reflecting almost 13 million individuals, reported never having been screened. After adjustment for socioeconomic status, health care access and Spanish language, disparities between whites and Blacks and Hispanics, but not Asians and Pacific Islanders, were eliminated.ConclusionsLower socioeconomic status, lack of healthcare access and language barriers explained most of the racial and ethnic disparities in cholesterol screening. Expanding insurance coverage, simplifying cardiac risk assessment and improving access to culturally and linguistically appropriate care hold the greatest promise for improving cardiovascular disease screening and treatment for vulnerable populations.