DETERMINANTS OF CHOLESTEROL SCREENING AND TREATMENT PATTERNS - INSIGHTS FOR DECISION-MAKERS

Background: Adult cholesterol screening and treatment policies by the National Cholesterol Education Program recommend that physicians scree n all adults aged greater than or equal to 20. On the other hand, the American College of Physicians recommends that healthy young adult men aged >35 and premenopausal women aged >45 not be screened due to conc erns about the cost of and health risks associated with overuse of pha rmacologic therapy in lieu of lifestyle modification. Objectives: The objectives of this study were to determine the type of treatment (life style vs. pharmacologic) that physicians actually prescribe for indivi duals screened for elevated cholesterol. Methods: Self-report data wer e derived from the 1989-1990 cross-sectional survey of the Stanford Fi ve-City Project on 1,883 Latino and Angle men and women aged 20 to '74 years of age. A four-stage sequential design was conducted using mult iple stepwise regression analyses with a significance cut-point of P < .01. Results: Young adult men and women were significantly less likel y to report ever having been screened (OR 1.02; 95% CI 1.01-1.09). Ind ividuals of low socioeconomic status (SES) were also significantly les s likely to report ever being screened (OR, 1.12; CI, 1.08-1.16), as w ere Latino men and women, regardless of age (OR 1.57; CI, 1.14-2.18). There were no significant differences in the pattern of physician care utilization among low SES or Latino individuals during the previous 1 2-month period. Among those under physician care to lower cholesterol, young adults were more likely to be prescribed lifestyle modification (OR, 0.95; CI, 0.92-0.98). Conclusions: Our results suggest that alth ough young adults are less likely to be screened, if screened they are more likely to be prescribed lifestyle modification than pharmacologi c treatment for elevated cholesterol. The lower prevalence of screenin g among low SES and Latino individuals suggests the need for policy di scussions to reduce these disparities.