Characteristics of Scientific Evidence Informing Changed U.S. Preventive Services Task Force Insufficient Evidence Statements


      The U.S. Preventive Services Task Force (USPSTF) issues “Insufficient Evidence” (I) statements when scientific evidence is inadequate for making recommendations about clinical preventive services. Insufficient Evidence statements may be changed to definitive recommendations if new research closes evidence gaps. This study examines the characteristics of evidence that informed changes from I statements to definitive recommendations, including NIH's role as a funder.


      A total of 11 USPSTF Insufficient Evidence statements that were changed between 2010 and 2019 were assessed. Study designs, bibliometric influence, and funding sources for scientific articles cited in USPSTF evidence reviews were characterized for each I statement. Data were analyzed in 2019–2020.


      Most I statements (82%) changed to a B grade; an average of 8.4 years elapsed between issuing the I statement and releasing the definitive recommendation. An average of 63 (range=19−253) articles were included in each USPSTF evidence review. NIH support was cited in 28.8% of articles, on average. The proportion of NIH-funded articles reporting RCT designs was similar to that of non–NIH-funded articles (64.5% vs 59.5%). A higher proportion of NIH-funded articles were rated good quality for study design (39.0%) than the proportion of non–NIH-funded articles (24.4%). Bibliometric influence measured by relative citation ratios was higher for NIH-funded (mean=14.78) than for non–NIH-funded (mean=5.07) articles.


      Study designs and funding supports varied widely across topics, but overall, NIH was the largest single funder of evidence informing 11 changed USPSTF I statements. Enhanced efforts by NIH and other stakeholders to address I statement evidence gaps are needed.
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      1. About the USPSTF. U.S. Preventive Services Task Force. Updated September 2021. Accessed February 25, 2021.

      2. U.S. Preventive Services Task Force . (USPSTF) insufficient evidence (I) statements. NIH, Office of Disease Prevention. Updated October 2021. Accessed February 25, 2021.

      3. Our partners. U.S. Preventive Services Task Force. Updated September 2021. Accessed February 25, 2021.

        • Dorsey ER
        • de Roulet J
        • Thompson JP
        • et al.
        Funding of U.S. biomedical research. 2003-2008.
        JAMA. 2010; 303: 137-143
        • 3rd Moses H
        • DH Matheson
        • Cairns-Smith S
        • George BP
        • Palisch C
        • Dorsey ER
        The anatomy of medical research: U.S. and international comparisons.
        JAMA. 2015; 313: 174-189
        • Viergever RF
        • Hendriks TC.
        The 10 largest public and philanthropic funders of health research in the world: what they fund and how they distribute their funds.
        Health Res Policy Syst. 2016; 14: 12
      4. NIH wide strategic plan: fiscal years 2016−2020.
        NIH, Bethesda, MD2015 (Published)
        • Villani J
        • Ngo-Metzger Q
        • Vincent IS
        • Klabunde CN.
        Sources of funding for research in evidence reviews that inform recommendations of the U.S. Preventive Services Task Force.
        JAMA. 2018; 319: 2132-2133
      5. Evidence-based Practice Center (EPC) program overview. Agency for Healthcare Research and Quality. Updated January 2021. Accessed February 25, 2021.

        • Hutchins BI
        • Yuan X
        • Anderson JM
        • Santangelo GM.
        Relative citation ratio (RCR): a new metric that uses citation rates to measure influence at the article level.
        PLoS Biol. 2016; 14e1002541
        • Nelson HD
        • Bougatsos C
        • Blazina I.
        Screening women for intimate partner violence: a systematic review to update the U.S. Preventive Services Task Force recommendation.
        Ann Intern Med. 2012; 156 (796–282)
        • Cushman WC
        • Evans GW
        • et al.
        • ACCORD Study Group
        Effects of intensive blood-pressure control in type 2 diabetes mellitus.
        N Engl J Med. 2010; 362: 1575-1585
        • Aberle DR
        • Adams AM
        • et al.
        • National Lung Screening Trial Research Team
        Reduced lung-cancer mortality with low-dose computed tomographic screening.
        N Engl J Med. 2011; 365: 395-409
        • Church TR
        • Black WC
        • et al.
        • National Lung Screening Trial Research Team
        Results of initial low-dose computed tomographic screening for lung cancer.
        N Engl J Med. 2013; 368: 1980-1991
        • Andriole GL
        • Crawford ED
        • Grubb 3rd, RL
        • et al.
        Mortality results from a randomized prostate-cancer screening trial [published correction appears in N Engl J Med. 2009;360(17):1797].
        N Engl J Med. 2009; 360: 1310-1319
        • Potosky AL
        • Reeve BB
        • Clegg LX
        • et al.
        Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy.
        J Natl Cancer Inst. 2002; 94: 430-437
        • Hoffman RM
        • Hunt WC
        • Gilliland FD
        • Stephenson RA
        • Potosky AL.
        Patient satisfaction with treatment decisions for clinically localized prostate carcinoma. Results from the Prostate Cancer Outcomes Study.
        Cancer. 2003; 97: 1653-1662
        • Kinsinger LS
        • Anderson C
        • Kim J
        • et al.
        Implementation of lung cancer screening in the veterans health administration.
        JAMA Intern Med. 2017; 177: 399-406
        • NIH, National Cancer Institute
        Smoking cessation within the context of lung cancer screening (R01).
        NIH, National Cancer Institute, Bethesda, MD2015 (Published June 5,)
        • NIH, National Cancer Institute
        Population-based Research to Optimize the Screening Process (PROSPR) (UM1).
        NIH, National Cancer Institute, Bethesda, MD2016 (Published October 24,)
        • Centers for Medicare & Medicaid Services
        National Coverage Determination (NCD): lung cancer screening with low dose computed tomography (LDCT).
        Centers for Medicare & Medicaid Services, Baltimore, MD2015 (Published May 2)
        • Murray DM
        • Kaplan RM
        • Ngo-Metzger Q
        • et al.
        Enhancing coordination among the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, and National Institutes of Health.
        Am J Prev Med. 2015; 49: S166-S173
        • Kurth AE
        • Krist AH
        • Borsky AE
        • et al.
        U.S. Preventive Services Task Force methods to communicate and disseminate clinical preventive services recommendations.
        Am J Prev Med. 2018; 54: S81-S87
      6. Reports to Congress. U.S. Preventive Services Task Force. Updated November 2020. Accessed February 25, 2021.

        • Epling JW
        • Borsky AE
        • Gerteis J.
        Improvements to the U.S. Preventive Services Task Force recommendation statement.
        JAMA. 2019; 322: 1143-1144
      7. Addressing evidence gaps in clinical prevention. The National Academies of Sciences, Engineering, and Medicine. Updated September 2021. Accessed February 25, 2021.

        • Li D
        • Azoulay P
        • Sampat BN.
        The applied value of public investments in biomedical research.
        Science. 2017; 356: 78-81
        • Galkina Cleary E
        • Beierlein JM
        • Khanuja NS
        • McNamee LM
        • Ledley FD
        Contribution of NIH funding to new drug approvals 2010–2016.
        Proc Natl Acad Sci U S A. 2018; 115: 2329-2334