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Abstract
OBJECTIVE Three-year changes in well-being were studied among family caregivers of an epidemiologically derived sample of stroke survivors from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and compared to matched noncaregivers. METHODS Family caregivers of REGARDS participants who experienced a stroke event completed telephone interviews assessing depressive symptoms, mental and physical health quality of life (QOL), life satisfaction, and leisure satisfaction at approximately 9, 18, 27, and 36 months after the stroke (n = 235). For each stroke caregiver, a family member of a stroke-free REGARDS participant was enrolled as a matched noncaregiving control (n = 235) and completed similar interviews. RESULTS Multilevel longitudinal models found that caregivers showed poorer well-being at 9 months poststroke than controls on all measures except physical health QOL. Significant differences were sustained for 22 months after the stroke event for depressive symptoms, 31 months for mental health QOL, and 15 months for life satisfaction. For leisure satisfaction, differences were still significant at 36 months poststroke. Caregiving effects were similar across race and sex. CONCLUSIONS Stroke caregiving is associated with persistent psychological distress, but life satisfaction, depression, and mental health QOL became comparable to noncaregivers by 3 years after stroke. Caregiver leisure satisfaction was chronically lower than in noncaregivers. Intervention for stroke caregivers should recognize both the strains faced by caregivers and their capacity for successful coping over time.
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Affiliation(s)
- William E Haley
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham.
| | - David L Roth
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| | - Martha Hovater
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| | - Olivio J Clay
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
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2
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Buys DR, Roth DL, Ritchie CS, Sawyer P, Allman RM, Funkhouser EM, Hovater M, Locher JL. Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up. J Gerontol A Biol Sci Med Sci 2014; 69:1146-53. [PMID: 24589863 DOI: 10.1093/gerona/glu024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years. METHODS Data are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures. RESULTS In adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models. CONCLUSIONS Nutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults.
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Affiliation(s)
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Patricia Sawyer
- Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, and
| | - Richard M Allman
- Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, and Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center Alabama
| | | | | | - Julie L Locher
- Department of Health Care Organizations and Policy, University of Alabama at Birmingham
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3
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Glasser SP, Hovater M, Brown TM, Howard G, Safford MM. Aspirin as Primary Prevention of Acute Coronary Heart Disease Events. BJMMR 2014; 4:5357-5367. [PMID: 26413491 PMCID: PMC4582790 DOI: 10.9734/bjmmr/2014/11212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Stephen P. Glasser
- Division of Preventive Medicine University of Alabama at Birmingham, 171711th Avenue South, Birmingham, AL, USA
- Corresponding author:
| | - Martha Hovater
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Todd M. Brown
- Division of Preventive Medicine University of Alabama at Birmingham, 171711th Avenue South, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Monika M. Safford
- Division of Preventive Medicine University of Alabama at Birmingham, 171711th Avenue South, Birmingham, AL, USA
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4
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Haas MC, Bodner EV, Brown CJ, Bryan D, Buys DR, Keita AD, Flagg LA, Goss A, Gower B, Hovater M, Hunter G, Ritchie CS, Roth DL, Wingo BC, Ard J, Locher JL. Calorie restriction in overweight seniors: response of older adults to a dieting study: the CROSSROADS randomized controlled clinical trial. J Nutr Gerontol Geriatr 2014; 33:376-400. [PMID: 25424512 PMCID: PMC4248142 DOI: 10.1080/21551197.2014.965993] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We conducted a study designed to evaluate whether the benefits of intentional weight loss exceed the potential risks in a group of community-dwelling obese older adults who were at increased risk for cardiometabolic disease. The CROSSROADS trial used a prospective randomized controlled design to compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition and adipose tissue deposition (Specific Aim #1: To compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition, namely visceral adipose tissue), cardiometabolic disease risk (Specific Aim #2: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on cardiometabolic disease risk), and functional status and quality of life (Specific Aim #3: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on functional status and quality of life). Participants were randomly assigned to one of three groups: Exercise Only (Control) Intervention, Exercise + Diet Quality + Weight Maintenance Intervention, or Exercise + Diet Quality + Weight Loss Intervention. CROSSROADS utilized a lifestyle intervention approach consisting of exercise, dietary, and behavioral components. The development and implementation of the CROSSROADS protocol, including a description of the methodology, detailing specific elements of the lifestyle intervention, assurances of treatment fidelity, and participant retention; outcome measures and adverse event monitoring; as well as unique data management features of the trial results, are presented in this article.
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Affiliation(s)
- Marilyn C Haas
- a Division of Gerontology, Geriatrics, and Palliative Care , University of Alabama at Birmingham , Birmingham , Alabama , USA
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5
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Roth DL, Haley WE, Hovater M, Perkins M, Wadley VG, Judd S. Family caregiving and all-cause mortality: findings from a population-based propensity-matched analysis. Am J Epidemiol 2013; 178:1571-8. [PMID: 24091890 DOI: 10.1093/aje/kwt225] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Previous studies have provided conflicting evidence on whether being a family caregiver is associated with increased or decreased risk for all-cause mortality. This study examined whether 3,503 family caregivers enrolled in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study showed differences in all-cause mortality from 2003 to 2012 compared with a propensity-matched sample of noncaregivers. Caregivers were individually matched with 3,503 noncaregivers by using a propensity score matching procedure based on 15 demographic, health history, and health behavior covariates. During an average 6-year follow-up period, 264 (7.5%) of the caregivers died, which was significantly fewer than the 315 (9.0%) matched noncaregivers who died during the same period. A proportional hazards model indicated that caregivers had an 18% reduced rate of death compared with noncaregivers (hazard ratio = 0.823, 95% confidence interval: 0.699, 0.969). Subgroup analyses by race, sex, caregiving relationship, and caregiving strain failed to identify any subgroups with increased rates of death compared with matched noncaregivers. Public policy and discourse should recognize that providing care to a family member with a chronic illness or disability is not associated with increased risk of death in most cases, but may instead be associated with modest survival benefits for the caregivers.
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6
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Gaugler JE, Hovater M, Roth DL, Johnston JA, Kane RL, Sarsour K. Depressive, functional status, and neuropsychiatric symptom trajectories before an Alzheimer's disease diagnosis. Aging Ment Health 2013; 18:110-6. [PMID: 23822174 PMCID: PMC3855584 DOI: 10.1080/13607863.2013.814100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This short report relied on multiyear data from the National Alzheimer's Coordinating Center - Uniform Data Set (NACC-UDS) to examine whether significant changes occurred in functional status, neuropsychiatric symptoms, and depressive symptoms in the years before receiving an Alzheimer's disease (AD) diagnosis. METHOD The secondary analysis used a retrospective cohort design. The NACC-UDS is a publicly accessible, longitudinal database that includes standardized data on neuropsychiatric symptoms, functional status, and depressive symptoms for Alzheimer's Disease Center (ADC) participants in the USA based on their annual visits from 2005 to 2011. ADC participants were considered diagnosed with AD if a follow-up data form indicated an affirmative response to whether the ADC participant had 'probable AD (National Institute of Neurological and Communicative Disorders and Stroke (NINCDS)/Alzheimer's Disease and Related Disorders Association (ADRDA))' or 'possible AD (NINCDS/ADRDA).' This yielded an analytic sample of 2478 individuals (139 with an eventual probable AD diagnosis, 109 individuals with an eventual possible AD diagnosis, and 2230 without any AD diagnosis) representing a total of 11,358 visits/points of data. RESULTS Multilevel linear models revealed significant decreases (p < 0.05) in functional status prior to a probable or possible AD diagnosis and significant increases in depressive symptoms prior to a probable AD diagnosis. DISCUSSION Changes in functional and depressive symptoms were partly independent of cognitive decline. The longitudinal results lend additional support to conceptual and empirical models of pre-diagnosis declines in AD.
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Affiliation(s)
- Joseph E Gaugler
- a School of Nursing, Center on Aging, University of Minnesota-Twin Cities , Minneapolis , MN , USA
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7
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Salanitro AH, Hovater M, Hearld KR, Roth DL, Sawyer P, Locher JL, Bodner E, Brown CJ, Allman RM, Ritchie CS. Symptom burden predicts hospitalization independent of comorbidity in community-dwelling older adults. J Am Geriatr Soc 2012; 60:1632-7. [PMID: 22985139 DOI: 10.1111/j.1532-5415.2012.04121.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults. DESIGN Prospective, observational study with a baseline in-home assessment of symptom burden. SETTING Central Alabama. PARTICIPANTS Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence. MEASUREMENTS Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined. RESULTS During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity. CONCLUSION Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization.
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Affiliation(s)
- Amanda H Salanitro
- Geriatric Research, Education and Clinical Center Veterans Affairs Tennessee Valley Healthcare, Nashville, Tennessee 37212, USA.
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8
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Shuaib FM, Durant RW, Parmar G, Brown TM, Roth DL, Hovater M, Halanych JH, Shikany JM, Howard G, Safford MM. Awareness, treatment and control of hypertension, diabetes and hyperlipidemia and area-level mortality regions in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. J Health Care Poor Underserved 2012; 23:903-21. [PMID: 22643632 DOI: 10.1353/hpu.2012.0045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Health Professional Shortage Areas (HPSA) receive extra federal resources, but recent reports suggest that HPSA may not consistently identify areas of need. PURPOSE To assess areas of need based on county-level ischemic heart disease (IHD) and stroke mortality regions. METHODS Need was defined by lack of awareness, treatment, or control of hypertension, diabetes, or hyperlipidemia. Counties were categorized into race-specific tertiles of IHD and stroke mortality using 1999-2006 CDC data. Multivariable logistic regression was used to model the relationships between IHD and stroke mortality region and each element of need. RESULTS Awareness and treatment of cardiovascular (CVD) risk factors were similar for residents in counties across IHD and stroke mortality tertiles, but control tended to be lower in counties with the highest mortality. CONCLUSIONS High stroke and IHD mortality identify distinct regions from current HPSA designations, and may be an additional criterion for designating areas of need.
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Affiliation(s)
- Faisal M Shuaib
- University of Alabama at Birmingham School of Medicine, USA.
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9
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Gaugler JE, Hovater M, Roth DL, Johnston JA, Kane RL, Sarsour K. Analysis of cognitive, functional, health service use, and cost trajectories prior to and following memory loss. J Gerontol B Psychol Sci Soc Sci 2012; 68:562-7. [PMID: 23009955 DOI: 10.1093/geronb/gbs078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES This brief report examines whether significant changes in cognition, functional dependence, health service use, and out-of-pocket medical expenditures (OOPMD) occur in the years prior to a physician-identified memory problem in a nationally representative sample of older adults. METHOD Longitudinal data from the RAND-Health and Retirement Survey were utilized. Those who reported a physician-identified memory problem (n = 387) were compared with a randomly selected control group of similar age, race, and gender who did not indicate a memory problem (n = 387). Multilevel linear models were used to construct trajectories for various measures of cognition, function, health service use, and OOPMD in the years prior to and following memory problem identification. RESULTS Several trajectories demonstrated significant rates of change in the years leading up to a physician-identified memory problem, including symptoms (mental status, fine motor skills, and instrumental activities of daily living) and utilization (OOPMD and overnight stays in hospital). DISCUSSION Preclinical declines in mental status and function and increases in hospital use and OOPMD are apparent prior to the formal identification of memory problems. Earlier identification of these changes might provide a basis for interventions that could alter the clinical course of dementia.
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Affiliation(s)
- Joseph E Gaugler
- School of Nursing, Center on Aging, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA.
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10
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Durant RW, Parmar G, Shuaib F, Le A, Brown TM, Roth DL, Hovater M, Halanych JH, Shikany JM, Prineas RJ, Samdarshi TJ, Safford MM. Awareness and management of chronic disease, insurance status, and health professional shortage areas in the REasons for Geographic And Racial Differences in Stroke (REGARDS): a cross-sectional study. BMC Health Serv Res 2012; 12:208. [PMID: 22818296 PMCID: PMC3571909 DOI: 10.1186/1472-6963-12-208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 07/04/2012] [Indexed: 01/01/2023] Open
Abstract
Background Limited financial and geographic access to primary care can adversely influence chronic disease outcomes. We examined variation in awareness, treatment, and control of hypertension, diabetes, and hyperlipidemia according to both geographic and financial access to care. Methods We analyzed data on 17,458 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study with either hypertension, hyperlipidemia, or diabetes and living in either complete Health Professional Shortage Area (HPSA) counties or non-HPSA counties in the U.S. All analyses were stratified by insurance status and adjusted for sociodemographics and health behaviors. Results 2,261 residents lived in HPSA counties and 15,197 in non-HPSA counties. Among the uninsured, HPSA residents had higher awareness of both hypertension (adjusted OR 2.30, 95% CI 1.08, 4.89) and hyperlipidemia (adjusted OR 1.50, 95% CI 1.01, 2.22) compared to non-HPSA residents. Also among the uninsured, HPSA residents with hypertension had lower blood pressure control (adjusted OR 0.45, 95% CI 0.29, 0.71) compared with non-HPSA residents. Similar differences in awareness and control according to HPSA residence were absent among the insured. Conclusions Despite similar or higher awareness of some chronic diseases, uninsured HPSA residents may achieve control of hypertension at lower rates compared to uninsured non-HPSA residents. Federal allocations in HPSAs should target improved quality of care as well as increasing the number of available physicians.
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Affiliation(s)
- Raegan W Durant
- University of Alabama at Birmingham School of Medicine, 1717 11th Avenue South, Birmingham, AL 35294, USA.
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11
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Brown TM, Parmar G, Durant RW, Halanych J, Hovater M, Muntner P, Prineas RJ, Roth D, Samdarshi TE, Safford MM. Abstract P42: Health Professional Shortage Areas, Insurance Status, and Cardiovascular Disease Prevention in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_1.ap42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Uninsured individuals and those living in federally designated Health Professional Shortage Areas (HPSA) face considerable access barriers and, consequently, may receive less cardiovascular disease (CVD) preventive care.
Methods:
REGARDS is a national cohort of 30,239 African American (AA) and White community dwelling individuals >45 years of age recruited between 2003 and 2007. We investigated 5 CVD prevention guidelines: 1) aspirin in those with coronary heart disease (CHD), 2) beta-blockers (BB) following myocardial infarction, 3) angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers in those with diabetes or CVD and either hypertension or chronic kidney disease, 4) statins in those with diabetes or CHD, and 5) warfarin for atrial fibrillation. We compared use of these medications by insurance status and HPSA county residence, adjusting for sociodemographics, health behaviors, and health status. Counties with partial HPSA status were excluded.
Results:
Mean age of participants was 64±9 years, 42% were AA, 55% were women, 93% were insured; 2,548 participants resided in complete HPSA counties and 17,441 in non-HPSA counties, representing 340 of 842 complete HPSA and 1,145 of 1,792 non-HPSA counties nationally. The odds of receiving aspirin, BBs, and ACEI by were similar by HPSA county type and insurance status. However, the odds of receiving statin therapy were lower among uninsured participants, regardless of county type (Table).
Conclusions:
Residence in HPSA counties was not associated with less CVD prevention. However, a combination of lack of insurance and residence in a HPSA county defined those with the lowest recommended statin use, suggesting lack of access to newer, more expensive therapies among those with both financial and geographic barriers to primary care.
Adjusted OR
*
(95% CI) for Recommended Medications Compared to Insured Residents of non-HPSA Counties
Aspirin
Beta-Blockers
ACEI or ARB
Statin
Warfarin
Insured residents of HPSA counties
1.19 (0.79-1.80)
1.05 (0.75-1.47)
1.08 (0.90-1.30)
1.01 (0.84-1.21)
1.42 (0.93-2.17)
Uninsured residents of non-HPSA counties
1.33 (0.66-2.64)
1.47 (0.78-2.74)
0.98 (0.75-1.28)
0.74 (0.57-0.96)
1.44 (0.65-3.21)
Uninsured residents of HPSA counties
0.92 (0.26-3.24)
1.01 (0.31-3.25)
0.98 (0.58-1.65)
0.54 (0.33-0.90)
**
*
Adjusted for age, race, gender, education, income, percent of county population below poverty, medication adherence, functional capacity, and depressive symptoms. ACEI=angiotensin converting enzyme inhibitor, ARB=angiotensin receptor blocker, CVD=Cardiovascular Disease, HPSA=Health Professional Shortage Area.
**
Adjusted OR not available due to few available individuals; unadjusted OR=0.14 (0.02-1.08).
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Affiliation(s)
| | | | | | | | | | | | | | - David Roth
- Univ of Alabama at Birmingham, Birmingham, AL
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Safford MM, Parmar G, Brown TM, Hovater M, Roth D, Halanych JH, Shikany JM, Prineas RJ, Samdarshi T, Durant RW. Abstract P28: Awareness and Management of CVD Risk Factors and Area-Level Mortality Regions in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_1.ap28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Federally designated Health Professional Shortage Areas (HPSA) receive extra resources, but recent reports suggest that HPSAs may not consistently identify areas of need. We examined an alternative approach to designating areas of need based on county-level ischemic heart disease (IHD) and stroke mortality rates.
Methods:
We examined participants in the REGARDS Study, a national cohort of 30,239 US community-dwelling adults (42% African Americans) aged ≥45 recruited 2003-7. “Need” was defined by awareness, treatment or control of hypertension (n=21,118), diabetes (6,355) or hyperlipidemia (21,096). Awareness and treatment were self-reported, and control was defined as BP <140/90 mmHg (<130/80 for diabetes or chronic kidney disease) for hypertension; fasting blood sugar <140 mg/dL (<200 if non-fasting) for diabetes; and LDL cholesterol <130 mg/dL for hyperlipidemia. Each county was categorized into race-specific tertiles of IHD and, separately, stroke mortality, using 1999-2006 CDC data (based on death certificates). Sociodemographics, health behaviors, physical functioning and insurance status were included in separate multivariable models describing the relationships between IHD and stroke mortality and each element of need.
Results:
Participants resided in 1821 US counties, 578 in the lowest IHD mortality tertile (597 for stroke), 628 in the medium (586), and 627 in the highest (638). Awareness and treatment of CVD risk factors were similar for residents in counties across IHD and stroke mortality tertiles, but control tended to be lower in counties in the highest mortality tertiles (Table).
Conclusions:
Research is needed to elucidate why some CVD risk factor control is worse in areas of high CVD mortality despite similar levels of awareness or treatment of disease between high and low mortality areas. High stroke and IHD mortality may be one way to designate areas of need for resource allocation…
Table.
Adjusted
*
OR (95% CI) for Residence in a County in the Highest vs. Lowest (ref) IHD and Stroke Mortality Tertiles,
**
for Awareness, Treatment, and Control of Hypertension, Diabetes and Hyperlipidemia.
Outcome
Hypertension
Diabetes
Hyperlipidemia
IHD
Stroke
IHD
Stroke
IHD
Stroke
Awareness
1.14 (0.97,1.35)
1.07 (0.90,1.28)
1.02 (0.78,1.34)
0.98 (0.73,1.31)
1.05 (0.94,1.17)
0.98 (0.87,1.10)
Treatment
1.10 (0.85,1.43)
0.80 (0.61,1.04)
1.21 (0.96,1.52)
1.12 (0.88,1.42)
1.06 (0.94,1.20)
1.02 (0.90,1.15)
Control
1.00 (0.89,1.12)
0.88 (0.78,0.99)
0.79 (0.64,0.96)
0.82 (0.64,1.05)
0.83 (0.70,0.98)
0.95 (0.80,1.14)
*
Adjusted for age, race, gender, education, income, urban/rural residence, alcohol/tobacco use, medication adherence, exercise, BMI, and functional status.
**
Race-specific tertiles.
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Affiliation(s)
| | | | | | | | - David Roth
- Univ of Alabama at Birmingham, Birmingham, AL
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Brown TM, Parmar G, Durant RW, Halanych JH, Hovater M, Muntner P, Prineas RJ, Roth DL, Samdarshi TE, Safford MM. Health Professional Shortage Areas, insurance status, and cardiovascular disease prevention in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. J Health Care Poor Underserved 2011; 22:1179-89. [PMID: 22080702 PMCID: PMC3586412 DOI: 10.1353/hpu.2011.0127] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Individuals with cardiovascular disease (CVD) living in Health Professional Shortage Areas (HPSA) may receive less preventive care than others. The Reasons for Geographic And Racial Differences in Stroke Study (REGARDS) surveyed 30,239 African American (AA) and White individuals older than 45 years of age between 2003-2007. We compared medication use for CVD prevention by HPSA and insurance status, adjusting for sociodemographic factors, health behaviors, and health status. Individuals residing in partial HPSA counties were excluded. Mean age was 64±9 years, 42% were AA, 55% were women, and 93% had health insurance; 2,545 resided in 340 complete HPSA counties and 17,427 in 1,145 non-HPSA counties. Aspirin, beta-blocker, and ACE-inhibitor use were similar by HPSA and insurance status. Compared with insured individuals living in non-HPSA counties, statin use was lower among uninsured participants living in non-HPSA and HPSA counties. Less medication use for CVD prevention was not associated with HPSA status, but less statin use was associated with lack of insurance.
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Affiliation(s)
- Todd M Brown
- University of Alabama at Birmingham, Division of Cardiovascular Diseases, USA.
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