Gender differences in the management of risk factors for cardiovascular disease: the importance of insurance status

Impact of local health insurance schemes on primary care management and control of hypertension: a cross-sectional study in Shenzhen, China

BACKGROUND

In China, the local health insurance coverage is usually related to timely reimbursement of hypertensive care in primary care settings, while health insurance that is not local could represent an obstacle for accessibility and affordability of primary care for hypertensive patients.

OBJECTIVE

To investigate whether local health insurance schemes have a positive impact on hypertension management and control.

DESIGN

We performed an on-site, face-to-face, patients survey in community health centres (CHCs) in Shenzhen, China.

SETTING AND PARTICIPANTS

Hypertensive patients seeking healthcare from CHCs were selected as study participants using a systematic sampling design.

MAIN MEASURES

We obtained information about insurance status, social capital, drug treatment and control of hypertension. Multivariable stepwise logistic regression models were constructed to test the associations between insurance status and hypertension management, as well as insurance status and social capital.

RESULTS

A total of 867 participants were included in the final study analysis. We found that the participants covered by local insurance schemes were more likely to be managed in primary care facilities (61.1% vs 81.9%; OR=2.58, 95% CI: 1.56 to 4.28), taking antihypertensive drugs (77.2% vs 88.0%; OR=2.23, 95% CI: 1.37 to 3.62) and controlling blood pressure (43.0% vs 52.4%; OR=1.46, 95% CI: 1.03 to 2.07) when compared with those with insurance coverage that is not local. The participants covered by local insurance schemes reported a higher score of perceived generalised trust than those without (4.23 vs 3.97; OR=0.74, 95% CI: 0.53 to 0.86).

CONCLUSION

Our study demonstrates that local health insurance coverage could help improve management and control of hypertension in a primary care setting. Policymakers suggest initiating social interventions for better management and control of hypertension at the primary care level, although the causal pathways across insurance status, social capital and control of hypertension deserve further investigations.

Cross-Sectional Study on the Management and Control of Hypertension Among Migrants in Primary Care: What Is the Impact of Segmented Health Insurance Schemes?

Background Information is scarce regarding the impact of fragmented health insurance schemes on the management and control of hypertension among migrants in primary care. This study aimed to investigate the relationship between insurance status and management and control of hypertension among migrants in primary care and to examine whether social capital could facilitate migrants' participation in local health insurance schemes. Methods and Results A site-based, cross-sectional, face-to-face patient survey was administered in Shenzhen, China. Hypertensive primary care users who were migrants were selected using a systematic sampling design. The participants covered by local health insurance schemes were more likely than those without coverage to be managed by primary care facilities (82.6% versus 62.0%; odds ratio=2.63, 95% CI 1.41-4.89) and to take antihypertensive medications (87.9% versus 76.4%; odds ratio=2.38, 95% CI 1.34-4.24), and they had higher scores in first contact use (3.49 versus 3.23; β=0.17, 95% CI 0.05-0.29) and continuity of care (3.17 versus 3.02; β=0.11, 95% CI 0.01-0.21). The participants covered by local insurance schemes had higher scores in perceived generalized trust than their counterparts (4.23 versus 3.95; β=0.16, 95% CI 0.09-0.40). The hypertension control rate was also higher among the participants with local health insurance coverage (48.8% versus 42.2%; odds ratio=1.38, 95% CI 1.02-2.12). Conclusions In conclusion, local health insurance schemes are associated with optimal control of hypertension for migrants compared with social health insurance schemes. Our study implies that one form of social capital, namely perceived general trust, contributes to migrant hypertensive patients' participation in local health insurance schemes.

Effect of Sociodemographic Variables and Other Factors on the Usage of Different Doses of Aspirin in Postmyocardial Infarction Patients: A Cross-sectional Study

Background:

Aspirin (acetylsalicylic acid) is commonly prescribed to patients with a history of myocardial infarction (MI) or occlusive vascular events (e.g., stroke). Due to the complications associated with failure to follow aspirin usage guidelines, determining predictors of aspirin noncompliance in these patient populations is of clinical value and may help prevent poor outcomes.

Methods:

This cross-sectional study of all patients with a previously diagnosed MI was conducted over a period of 3 months from May 2015 to July 2015 at a government-based hospital in Karachi, Pakistan. Patients were administered a questionnaire that comprised two parts. Part A was designed to measure sociodemographic data including age, gender, and marital status. Part B determined whether the patient was counseled on aspirin significance, and dosage recommendation, and was participating in cardiac rehabilitation therapy.

Results:

A total of 456 patients included in the study. Of them, 298 (66.7%) were males. The average age was 59 (standard deviation 11) years. The outcome from univariate logistic regression revealed that with 1 year increase of age, the usage of low dose of aspirin was significantly decreased by 2%. Patients with higher education attributed a significantly different effect on the usage of aspirin. Marital status divulged no significant association with the use of different doses of aspirin. The role of rehabilitation had no effect when adjusted for age and level of education.

Conclusion:

Post-MI patients with higher education level and undergoing rehabilitative therapy are more likely to take low-dose aspirin as compared to those who failed to have these attributes. There is a need for carrying out further work to confirm these findings and expand our recommendations, particularly the sensitive issue regarding adequate doctor counseling among these high-risk patients.

Low-income fathers' access to health insurance

We examine the prevalence and correlates of health insurance status among low-income fathers, a group not previously studied in this context. In a sample of 1,653 low-income fathers from a national urban birth cohort study, 29% had private, 14% had public, and 58% had no insurance. Privately insured fathers had greater levels of human capital than did publicly insured fathers; the latter more closely resembled uninsured fathers than they did privately insured fathers. Multinomial logistic regression analysis indicates that being older, being employed, being married, and having a job offering health insurance all increase the likelihood of having private (vs. no) insurance, and that being disabled and married to or cohabiting with the child's mother increase the likelihood of having public (vs. no) insurance. Public policy should focus on increasing access to health insurance among low-income men, which may improve their health, productivity, and ability to support themselves and their children.