OBJECTIVES: Cardiovascular diseases are the leading cause of death in the United States even though they are largely preventable and studies in. the US have established disparities in health outcomes. This study aimed to explore factors influencing racial and ethnic disparities in the use of preventive health services for CVD amongst adults in the US.

METHODS: The household component of the Medical Expenditure Panel Survey data, 2018, was used to elucidate information about the use of preventive health service for cardiovascular diseases (CVD). The analytical cohort included all adults 18 years and above with no established CVD (including coronary artery disease, angina, heart attacks, arrythmias and heart failure), N=15,896 (Wt. N=179,854,904). Multivariable logistic regression was performed to examine racial/ethnic disparity in CVD preventive counselling services use, controlling for predisposing, enabling, and need factors. The nonlinear Blinder Oaxaca Decomposition (BOD) was used to identify the percentage of contribution of each predisposing, enabling, and need factors in explaining the existing racial/ethnic disparity in CVD preventive service use.

RESULTS: Non-Hispanic Blacks were 56% (OR:0.044, 95%CI:0.38-0.83) less likely to use CVD preventive counseling services compared with non- Hispanic Whites, whereas no difference was observed between Hispanics and non-Hispanic Whites. The nonlinear BOD estimated a decomposition coefficient of -0.0015 indicating that the observed disparity would have been 68.2% higher (-0.0015/0.0022) if Hispanics had similar characteristics as whites. Although age, gender, educational status and marital status were significant factors (p<0.001) in the decomposition model, only marital status explained the racial/ethnic disparity.

CONCLUSIONS: The study revealed the existence of disparities but the differences in the predisposing, enabling, and need characteristics of this cohort did not successfully explain the racial/ethnic disparity in CVD preventive service use. There is need for further studies that examine the correlates of preventive services including individual beliefs, behavioral patterns, and provider prescription patterns.