Adults with CF in US making use of general, preventive care screenings
But study, in privately insured patients, finds checkups lacking in young adults
Adults with cystic fibrosis (CF) make as much use of most routine preventive healthcare services as adults in the general population, and in some cases more than they do, according to a recent analysis of U.S. insurance claims data.
This services — of growing importance as CFTR modulator therapies help patients live longer — include age-appropriate colonoscopies, mammograms, and cholesterol testing. But young adults with CF, especially those ages 18 to 26, were less likely than their peers to go for general health checks each year.
“Despite prior studies suggesting low use of preventive services, we found comparable-to-superior rates of preventive service utilization among privately insured adults with CF, compared to adults in the [general population],” the researchers wrote.
“Long-term maintenance of current screening rates will likely require a paradigm shift: the thoughtful integration of [primary care providers] into the CF comprehensive care model, targeted attention to vulnerable transitional-age adults with CF, and diligent adherence to screening guidelines,” they added.
General preventive care is of increasing importance with cystic fibrosis
While lung disease historically has been a main focus of CF care, a longer lifespan is bringing new health considerations to the forefront. Age-related conditions long observed in the general population, such as cardiovascular disease and cancer, may begin to emerge in the CF population.
Patients in their reproductive years increasingly may be interested in sexual health and pregnancy care.
“Therefore, it is increasingly important for PwCF [people with CF] to access preventive primary care services to ensure primary prevention, detection, and early treatment of extra-pulmonary diseases,” the researchers wrote.
Previous studies have indicated that preventive care services may not be fully utilized by CF patients, particularly adults. Many routinely receive speciality CF or lung care, but they may not have a general practitioner to deal with more routine health checks.
Scientists, led by those at The Ohio State University, examined the use of preventive healthcare services among 25,369 adults with CF (median age of 30), and 488,534 adults from the general U.S. population (median age of 38). Data were obtained from an insurance claims database containing information on more than 240 million U.S. residents covered under employer-provided or private insurance.
The database was screened for information related to the use of age-appropriate preventive services on their generally recommended schedule (e.g., annually, every 10 years, etc.).
Among screenings evaluated were dyslipidemia panels to look at blood levels of cholesterol and other fats (lipids), and colonoscopies to look into intestinal health. For women, assessed screenings were for chlamydia, a sexually transmitted infection; pap smears to evaluate cervical health; and mammograms for breast health.
Screening rates high for adults 40 and older, low among those in their 20s
In general, usage rates for these services were similar between the two groups, but final adjusted statistical analyses found that CF patients had higher utilization rates for several services than did the general public.
The largest differences were observed in lipid panels, where CF patients had a 43% higher utilization than in the general population, colonoscopies (26% higher utilization), and mammograms (21% higher usage).
Findings suggest that “clinicians caring for PwCF are beginning to recognize the emergent risks of breast cancer, colon cancer, and heart disease in this population,” the researchers noted.
Chlamydia screening and pap smears in women ages 18-24 did not differ between those with CF and those without it.
Overall, 43% of those in the CF population went for annual general health checkups, compared with 39% in the general population. Final adjusted analyses found that among adults ages 40 and older, CF patients had a 14% higher use of this service than did adults in general.
But younger adults with CF were less likely to go for general yearly checkups than their age-matched peers. Specifically, patients ages 18-26 used this service 35% less than their peers, while patients ages 27-39 used it 8% less.
Scientists believe these findings underscore a known care gap for young adult CF patients as they transition from pediatric to adult care.
“Specialty clinics fall short of addressing primary care and general health needs of patients with chronic illnesses that persist from childhood to adulthood,” the scientists wrote.
Altogether, “our findings establish the importance of meeting the primary care needs of adults with CF and call for development of strategies to improve preventive service delivery to young adults,” the researchers wrote.
As this study involved privately insured patients, its findings may not be generalizable to the roughly 40% of CF patients in the U.S. without commercial health insurance, who may lack similar access to preventive services, the scientists noted.