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Weprin SA, Parker DC, Jones JD, Kaplan JR, Giusto LL, Mydlo JH, Yu SJS, Lee DI, Eun DD, Reese AC. Association of Low Socioeconomic Status With Adverse Prostate Cancer Pathology Among African American Men Who Underwent Radical Prostatectomy. Clin Genitourin Cancer 2019; 17:e1054-e1059. [DOI: 10.1016/j.clgc.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/02/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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Hartz JC, Yellen E, Baker A, Zachariah J, Ryan H, Griggs SS, K Desai N, Yanumula R, Vinci S, Brantley C, Bachman J, McAuliffe E, Gauvreau K, Mendelson M, de Ferranti S. The relationship between payer type and lipid outcomes in response to clinical lifestyle interventions in youth with dyslipidemia. BMC Pediatr 2019; 19:217. [PMID: 31266458 PMCID: PMC6604145 DOI: 10.1186/s12887-019-1593-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/20/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Payer-type (government-sponsored health coverage versus private health insurance) has been shown to influence a variety of cardiovascular disease outcomes in adults. However, it is unclear if the payer-type impacts the response to a lifestyle intervention in children with dyslipidemia. METHODS We analyzed data prospectively collected from patients under the age of 25 years who were referred to a large regional preventive cardiology clinic from 2010 to 2016 in Massachusetts. We compared baseline high density lipoprotein cholesterol (HDL-C), triglycerides (TG), non-HDL-C, and low density lipoprotein cholesterol (LDL-C) by payer-type. Further, we analyzed the change in lipid values in response to a clinic-based multidisciplinary intervention over a nearly six-year period by payer-type with multi-variable adjusted linear regression models. We also tested for effect modifications by age, sex, race, and body mass index (BMI) category. RESULTS Of the 1739 eligible patients (mean age 13 years, 52% female, 60% overweight and obese, 59% White), we found that patients with government-sponsored coverage (n = 354, 20%) presented to referral lipid clinic with lower HDL-C (- 3.5 mg/dL [1.0], p < 0.001) and higher natural log-transformed TG (+ 0.14 [0.04], p < 0.001) as compared to those with private insurance; however, the association was attenuated to the null after additionally adjusting for BMI category (- 1.1 [0.9], p = 0.13, and + 0.05 [0.04], p = 0.2 for HDL-C and natural log-transformed TG, respectively). We found no difference in baseline LDL-C between payer-types (+ 3.4 mg/dL [3.0], p = 0.3). However, longitudinally, we found patients with private insurance and a self-reported race of White to have a clinically meaningful additional improvement in LDL-C, decreasing 12.8 (5.5) mg/dL (p = 0.02) between baseline and first follow-up, as compared to White patients with government-sponsored health coverage, after adjusting for age, sex, time between visits, and baseline LDL-C. CONCLUSIONS Our results suggest that youth with government-sponsored coverage are referred with poorer lipid profiles than those with private insurance, although this is largely explained by higher rates of overweight and obesity in the government-sponsored health coverage group. White patients with private insurance had substantially better improvement in LDL-C longitudinally, suggesting that higher socioeconomic status facilitates improvement in LDL-C, but is less beneficial for HDL-C and triglyceride levels.
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Affiliation(s)
- Jacob C. Hartz
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Elizabeth Yellen
- 0000 0001 2183 6745grid.239424.aBoston Medical Center, 850 Harrison Ave., 6th floor, Boston, MA 02118 USA
| | - Annette Baker
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Justin Zachariah
- 0000 0001 2200 2638grid.416975.8Texas Children’s Hospital Main Campus, 6651 Main Street, Legacy Tower, 21st Floor, Houston, TX 77030 USA
| | - Heather Ryan
- 0000 0004 0386 3207grid.266685.9School of Nursing, University of Massachusetts-Boston, 100 William T. Morrissey Blvd, Boston, MA 0212 USA
| | - S. Skylar Griggs
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Nirav K Desai
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Ravi Yanumula
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Samuel Vinci
- 0000000122986657grid.34477.33School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
| | - Caroline Brantley
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Jennifer Bachman
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Ellen McAuliffe
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Kimberlee Gauvreau
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Michael Mendelson
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Sarah de Ferranti
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
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