(363) Preventive Service Utilization among Cystic Fibrosis Adults with Private Insurance is Comparable to the General Population

Background: As the life expectancy of the cystic fibrosis (CF) population is actively lengthening with modulator therapies, it is unclear how these patients seek primary care services. Many rely upon clinicians at CF Centers for many aspects of clinical care with limited involvement of primary care providers. As these patients live further into adulthood, diligent age-appropriate screening and preventive care is vital for long-term health. Previous survey-based studies have suggested that CF adults have low preventive service utilization, though these investigations are limited by small cohorts, reliance on patient recall, and lack of comparison to a control group. This study sought to assess the baseline utilization of preventive services in adults with CF compared with the general population (GP).

Methods: We performed a retrospective analysis of CF and GP adults with commercial insurance by querying the IBM Watson Health MarketScan database between 2012-2018 and quantitating the following services: annual preventive visit, colorectal cancer screening via colonoscopy, cervical cancer screening via pap smears, chlamydia testing, and breast cancer screening via mammography. Screening rates are expressed per 100 person-years to account for individuals who entered and exited the database and/or guideline screening age windows within our study period.

Results: A total of 25,369 CF and 488,534 GP patients were included in this study. The unadjusted utilization rates per 100 person-years were measured (CF versus GP adults, respectively): 43% vs. 39% received an annual preventive visit, 28% vs 28% of 18–24-year-old females were screened for chlamydia, 38% vs. 37% of 21-29-year-old females received pap smears every 3 years, 33% vs 31% of 30-64-year-old females received pap smears every 5 years, 55% vs 44% of females >50 years old received mammograms, and 23% vs. 21% received colonoscopies (CF >40 years old vs. GP 50-75-years-old) (Table 1). We calculated incidence rate ratios (IRR) to assess whether screening rates statistically differed between CF and GP adults. Across all preventive services assessed, IRRs were ~1-1.25, indicating equivalent or slightly higher screening rates in CF adults versus GP adults.

Conclusions: To our knowledge, this represents the largest objective study to-date measuring preventive service utilization in CF patients and found comparable-to-superior rates of preventive service utilization in CF adults compared to GP adults. In the era of highly effective modulator therapy, the CF adult population is expected to grow older, encompassing an increasing proportion of the CF patient population. As CF patients age, they will face heightened risks for extrapulmonary complications and aging-related processes, including cardiac disease and malignancies. Preventive services will remain crucial to curb the morbidity and mortality effects of these conditions. Despite our encouraging findings, this study provides a strong rationale for sustained attention to the primary care needs of CF adults. As the burden to maintain current screening rates increases, close cooperation between CF specialists and primary care physicians may be required to meet the healthcare demands of these vulnerable patients.

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