The U.S. Preventive Services Task Force (USPSTF) has released its “11th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services.”
In 2021, the USPSTF continued to fulfill its mission of improving the health of people nationwide by making evidence-based recommendations about clinical preventive services such as screening tests, counseling about healthy behaviors, and preventive medications. These recommendations help clinicians and their patients make informed health care decisions.
In this annual report, the USPSTF calls attention to high-priority research gaps related to health equity from recent recommendations on cardiovascular disease and cancer prevention. This report is part of the Task Force’s long-standing commitment to advancing health equity.
Read the executive summary below or access the full report here.
Executive Summary
The U.S. Preventive Services Task Force (USPSTF or Task Force) is an independent, volunteer panel of national experts in prevention, primary care, and evidence-based medicine. The Task Force makes evidence-based recommendations about clinical preventive services to improve the health of people nationwide. The Task Force comprehensively assesses the potential benefits and harms of services, including screening tests, behavioral counseling, and preventive medications, to prevent disease in people without signs or symptoms.
Each year, Congress charges the USPSTF to provide a report that identifies gaps in the scientific evidence base and recommends areas for future research. In some cases, clinical preventive services have been well studied, but there are important evidence gaps that prevent the USPSTF from making recommendations for specific populations. The Task Force recognizes disparities persist in healthcare and health outcomes based on age, race and ethnicity, sex and gender, sexual orientation, and social risk factors. Greater inclusion of populations disproportionately affected by health conditions in research will help the USPSTF issue recommendations that improve the quality of preventive care. In turn, this will hopefully lead to improved access to and use of these preventive services, reduced disparities in healthcare, and increased health equity.
In this 11th annual report to Congress, which covers fiscal year 2021, the Task Force calls for more research in areas where evidence is lacking for populations disproportionately affected by health conditions.
Where More Research Is Needed Related to Health Equity in Cardiovascular Disease and Cancer Prevention
In this report, the USPSTF calls attention to high-priority research gaps from its recent recommendations related to health equity in cardiovascular disease and cancer prevention. The Task Force has a long-standing commitment to, and specific methods for, evaluating the evidence for clinical preventive services and making recommendations that promote health equity. Systemic racism affects every aspect of our society—including health and healthcare. It can prevent some people from accessing and receiving their recommended healthcare and increase the risk of illness. By proactively searching for data on populations historically underrepresented in research and disproportionately affected by health conditions, calling for new research to fill in existing gaps, and communicating as clearly as possible about how to support people’s varying health needs, we believe our approach will help improve equity in preventing diseases.
The research gaps highlighted in this report pertain to various issues in terms of health equity, including inclusion in research, benefits and harms, risk stratification, and implementation of preventive services. Research to address these complex health equity issues will help clinicians provide equitable care and meaningfully assist patients in preventing cardiovascular disease and cancer.
Specifically, more research is needed on the following topics to fill the evidence gaps described below.
Cardiovascular Disease
- Screening for Hypertension in Adults
- Include people who are historically underrepresented in research and populations disproportionately affected by hypertension in studies to determine optimal screening frequencies and strategies.
- Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality
- Recruit enough people from populations that bear the greatest disease burden, such as Black people, to be able to determine the effectiveness of different aspirin dosages and timing of initiation.
- Assess the populations most likely to benefit from aspirin prophylaxis and what risk threshold and factors should be used to identify eligible patient populations.
- Improve effective and equitable implementation of clinical guidelines for aspirin use in pregnancy.
- Screening for Prediabetes and Type 2 Diabetes
- Examine the effects of screening on health outcomes in populations disproportionately affected by diabetes, particularly racial and ethnic groups that have a higher prevalence of diabetes than White people.
- Assess the effects of lifestyle interventions and medical treatments for screen-detected prediabetes and diabetes on health outcomes over a longer followup period, particularly in populations with the highest prevalence of diabetes.
- Assess how best to increase uptake of lifestyle interventions, especially among populations at highest risk for progression to diabetes and adverse health outcomes.
- Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors
- Include and evaluate online resources such as daily caloric intake applications or other low-intensity approaches that may be valuable in low-resource settings.
Cancer
- Screening for Lung Cancer
- Assess the benefits and harms of using risk prediction models to select patients for lung cancer screening, including whether the use of risk prediction models represents a barrier to lung cancer screening in primary care.
- Evaluate how best to increase the uptake of lung cancer screening discussions in clinical practice, particularly among people at higher risk of death from lung cancer and people who are socially and economically disadvantaged (for whom smoking prevalence and lung cancer incidence is higher).
- Screening for Colorectal Cancer
- Evaluate the effectiveness of screening in adults younger than age 50 years and whether screening strategies should differ in younger versus older populations.
- Assess the factors that contribute to increased colorectal cancer incidence and mortality in Black adults, such as access to and availability of care and characteristics of systems providing healthcare. Once these factors are identified, more research is needed to evaluate interventions designed to mitigate these differences for Black adults.
Future research in these areas can help fill these gaps to help to improve the health of people nationwide, including populations disproportionately affected by health conditions. For example, future research may result in important new recommendations or help inform policy to improve access to and use of these preventive services, reduced disparities in healthcare, and increased health equity. The USPSTF hopes that identifying evidence gaps and highlighting them as research priorities will inspire public and private researchers to collaborate and target their efforts to generate new knowledge, address important health issues, and improve health equity.