WASHINGTON -- What preventive health measures would save the most lives for the least money?
The top rank goes to taking aspirin daily to prevent heart attacks and strokes in men over 40 and women over 50, according to a study reported Wednesday on the Web site of an alliance of health insurers, state health departments, academics, and trade groups.
Immunizing children and discouraging people from smoking follow closely behind, the Washington-based Partnership for Prevention found. Former Surgeon General David Satcher led the effort, which entailed a review of more than 8,000 preventive-medicine studies. The rankings are intended as a checklist for patients, doctors and insurers.
Below are the top 20 preventive measures in rank order. Preventive measures that are ignored by more than half of those who'd benefit from them are indicated by asterisks.
*Daily aspirin to prevent heart attacks and stroke in men over 40 and women over 50.
Childhood immunizations for diphtheria, tetanus, whooping cough, measles, mumps, rubella, polio, hepatitis B, etc.
*Tobacco-use screening and brief counseling by doctors.
*Routine colorectal-cancer screening for adults 50 and older by any recognized method.
Hypertension screening via routine blood-pressure tests and medication if necessary.
Annual flu shots for adults 50 and older.
*Immunization of adults 65 and older against bacteria that cause pneumonia and related diseases.
*Screening and brief counseling of problem drinkers by their physicians.
*Vision screening for adults 65 and older.
Cervical cancer screening for sexually active women and women over 21.
Cholesterol screening for men 35 and older and women 45 and older.
Routine breast-cancer screening for women 50 and older and discussion with women ages 40 to 49 to set an age to begin screening.
*Routine chlamydia screening for sexually active women under 25.
Calcium-supplement counseling for adolescent girls and women.
Vision screening for children under 5.
Routine counsel for women of childbearing age on the use of folic acid supplements to prevent birth defects.
Obesity screening for adults and high-intensity diet and exercise counseling for the obese.
Depression screening for adults.
Hearing-impairment screening for adults 65 and over.
Promotion of child-safety measures such as car seats, pool fences, bicycle helmets, poison control, and curbs on scalding-water burns.
''Next time you're at the doctor, you can use this list to start a conversation about preventive health actions," said the study's co-author, Ashley Coffield, the senior analyst for the group.
Analysts quantified the health gains in terms of longer life and better quality of life for each preventive measure. They also compared the cost-effectiveness of each preventive intervention. Finally, they combined the two rankings into one score that measures bang-for-the-buck for the top preventive-care options.
Of the 10 preventive measures that promise the greatest gains, six are ignored by more than half of Americans who'd benefit from them, according to the study, which also appears in the July issue of the American Journal of Preventive Medicine.
To read the study, which ranks 25 preventive measures, and to learn more about prevention-based strategies to improve US health, go to www.prevent.org/content/view/46/96/.