Preventive care adherence remains uneven across eight US racial and ethnic groups
Preventive care is designed to catch disease early, yet a national survey of US adults shows that access to screening and vaccination still varies sharply by racial and ethnic group. In a diverse cohort drawn from eight major populations, adherence to guideline-based services fell short of public health goals in nearly every group examined, with especially visible gaps in vaccination and, in one subgroup, cervical cancer screening.
The findings matter because preventive services are not abstract quality metrics. They are the point at which hypertension is identified before stroke, dyslipidemia before myocardial infarction, and vaccine-preventable disease before hospitalization. When those touchpoints are missed, downstream morbidity becomes more likely, and the burden falls unevenly across communities already carrying higher barriers to care.
National survey captures groups often missing from preventive care research
The PREVentive Care AdheREnce in Diverse Populations study surveyed 4,111 US adults from June through August 2023. Participants were at least 35 years old and identified as American Indian or Alaska Native, Asian, Black, Latino, Middle Eastern or North African, Native Hawaiian or Pacific Islander, White, or multiracial. The design is notable because it moves beyond the usual three-group framing of White, Black, and Latino populations and places all eight major racial and ethnic populations into the same analytic frame.
Researchers examined adherence to blood pressure screening, cholesterol screening, breast cancer screening, cervical cancer screening, colorectal cancer screening, influenza vaccination, shingles vaccination, and pneumococcal vaccination. Multivariable Poisson regression estimated the association between race and/or ethnicity and preventive service adherence, with additional ethnicity-stratified analyses among Asian, Latino, and Native Hawaiian or Pacific Islander participants.
Vaccination adherence showed the clearest shortfalls
Several of the largest gaps emerged in vaccine uptake. Compared with White adults, American Indian or Alaska Native adults were less likely to meet influenza vaccination guidance, with a prevalence ratio of 0.82 and a 95% confidence interval of 0.69 to 0.98. Their shingles vaccination adherence was also lower, with a prevalence ratio of 0.76, although the confidence interval crossed unity.
Black adults also showed lower shingles vaccination adherence, with a prevalence ratio of 0.75 and a 95% confidence interval of 0.54 to 1.06. Among Spanish-speaking Latino adults, pneumococcal vaccination adherence was lower than in White adults, with a prevalence ratio of 0.78 and a 95% confidence interval of 0.51 to 1.19. Middle Eastern or North African adults had lower influenza vaccination adherence, with a prevalence ratio of 0.75 and a 95% confidence interval of 0.62 to 0.92. Multiracial adults also had lower influenza and shingles adherence, with prevalence ratios of 0.84 and 0.53, respectively.
The pattern is clinically important because adult vaccination is often a last line of defense against respiratory and invasive infections in older populations. Lower uptake can reflect mismatched communication, limited continuity with primary care, competing social demands, insurance or cost barriers, and lower trust in health systems that have not consistently delivered equitable care.
Cervical screening gaps appeared in Middle Eastern or North African women
A narrower but meaningful disparity emerged in cancer screening. Middle Eastern or North African women were less likely to undergo cervical cancer screening, with a prevalence ratio of 0.85 and a 95% confidence interval of 0.62 to 0.92. Cervical screening depends on regular interaction with preventive care, and even a modest relative shortfall can translate into delayed detection of precancerous lesions when participation is uneven across a population.
No single biological explanation accounts for the difference. The more plausible drivers are structural and behavioral: differences in health literacy, language access, prior experiences with clinicians, comfort discussing reproductive health, and whether preventive care is offered in settings where patients already feel seen and understood.
Most groups still fell short of Healthy People 2030 targets
Across the preventive services measured, almost all racial and ethnic populations remained below Healthy People 2030 targets. The wording is plain, and the implication is larger than any one prevalence ratio. The gap is not limited to a single service, a single state, or a single population. It spans screening and vaccination, and it persists even in a contemporary nationally representative sample.
The survey design also makes the disparities harder to dismiss as an artifact of convenience sampling. By including American Indian or Alaska Native, Asian, Black, Latino, Middle Eastern or North African, Native Hawaiian or Pacific Islander, White, and multiracial adults in one study, the analysis exposes differences that often remain invisible when underrepresented groups are collapsed into broad categories or excluded altogether.
Health beliefs and access barriers remain the likely drivers
The most direct next step is to understand why preventive care is being missed. Health beliefs shape whether people view asymptomatic screening as necessary. Access barriers determine whether they can act on that belief. Language discordance, discrimination, fragmented care, insurance instability, and previous negative encounters all can suppress preventive service use long before a diagnosis is ever made.
Those mechanisms are not theoretical. They are the pathway through which a missed flu shot becomes preventable infection, a skipped shingles vaccine becomes pain and postherpetic complications, and an absent screening test becomes delayed cancer detection. The study’s results point toward intervention points in primary care, community outreach, language-concordant counseling, and culturally responsive preventive care delivery.
One finding stands out for its consistency: preventive care gaps remain widespread even in a survey built to measure them more accurately.
Future work will need to identify which barriers carry the greatest weight in each population and which interventions narrow the gap in real-world practice. Until then, the data leave a clear clinical message: preventive care in the United States is still not reaching all communities at the same rate, and the shortfalls are measurable across multiple services, not just one.