Access to Care and Cardiovascular Disease Prevention

Alcalá, Héctor E.; Albert, Stephanie L.; Roby, Dylan H.; Beckerman, Jacob P; Champagne, Philippe; Brookmeyer, Ron; Prelip, Michael; Glik, Deborah C.; Inkelas, Moira; Garcia, Rosa Elenna; Ortega, Alexander N.

doi:10.1097/md.0000000000001441

Cited by 35 publications

(19 citation statements)

References 28 publications

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“…Insurance plays a critical role in increasing access to certain types of preventive services, especially laboratory testing, inclusive of lipid and glucose screenings, which were elevated among recent immigrants. Uninsured persons are less likely to use preventive screenings for CVD, causing them to delay or forgo treatment (Alcala et al., ).…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk in Middle‐Aged and Older Immigrants: Exploring Residency Period and Health Insurance Coverage

Sadarangani

Trinh‐Shevrin

Chyun

et al. 2019

J of Nursing Scholarship

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Purpose It is reported that while immigrants are, initially, healthier than the native‐born upon resettlement, this advantage erodes over time. In the United States, uninsured aging immigrants are increasingly experiencing severe complications of cardiovascular disease (CVD). The purpose of this study was to compare overall CVD risk and explore the importance of health insurance coverage on CVD risk relative to other health access barriers, from 2007 to 2012, in recent and long‐term immigrants >50 years of age. Methods This study was based on secondary cross‐sectional analysis of the National Health and Nutrition Examination Survey (N = 1,920). The primary outcome, CVD risk category (high or low), was determined using the American College of Cardiology and American Heart Association Pooled Cohort equation. Differences between immigrant groups were examined using independent‐samples t tests and chi‐square analysis. The association between insurance and CVD risk was explored using a hierarchical block logistic regression model, in which variables were entered in a predetermined order. Changes in pseudo R2 measured whether health insurance explained variance in cardiac risk beyond other variables. Results Recent immigrants had lower overall CVD risk than long‐term immigrants but were twice as likely to be uninsured and had higher serum glucose and lipid levels. Based on regression models, being uninsured contributed to CVD risk beyond other health access determinants, and CVD risk was pronounced among recent immigrants who were uninsured. Conclusions Health insurance coverage plays an essential part in a comprehensive approach to mitigating CVD risk for aging immigrants, particularly recent immigrants whose cardiovascular health is susceptible to deterioration. Clinical Relevance Nurses are tasked with recognizing the unique social and physical vulnerabilities of aging immigrants and accounting for these in care plans. In addition to helping them access healthcare coverage and affordable medication, nurses and clinicians should prioritize low‐cost lifestyle interventions that reduce CVD risk, especially diet and exercise programs.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk in Middle‐Aged and Older Immigrants: Exploring Residency Period and Health Insurance Coverage

Sadarangani

Trinh‐Shevrin

Chyun

et al. 2019

J of Nursing Scholarship

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“…Access to comprehensive, quality healthcare is important for promoting and maintaining health, preventing and managing chronic disease and reducing unnecessary disability and premature death [2]. For instance, having a usual source of care is a more robust predictor than insurance status for healthcare utilization, cardiovascular disease screening, or receipt of information from healthcare providers about necessary lifestyle changes and inadequate hypertension management [3,4]. For individuals who have experienced an acute myocardial infarction, lack of a usual source of care is associated with higher mortality rates compared to those reporting stronger relationships with a regular physician [5].…”

Section: Introductionmentioning

confidence: 99%

Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study

et al. 2020

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Neighborhood environment perception (NEP) has been associated with health outcomes. However, little is known about how NEP relates to routine healthcare utilization. This study investigated the relationship between NEP and independent subfactors with healthcare utilization behavior, as measured by self-reported (1) usual source of healthcare and (2) time since last routine healthcare checkup. We used cross-sectional data from the Dallas Heart Study, which features a diverse, probability-based sample of Dallas County residents ages 18 to 65. We used logistic regression modeling to examine the association of self-reported NEP and routine healthcare utilization. NEP was assessed via a questionnaire exploring residents' neighborhood perceptions, including violence, the physical environment, and social cohesion. Routine healthcare utilization was assessed via self-reported responses regarding usual source of care and time since last routine healthcare checkup. The analytic sample (N = 1706) was 58% black, 27% white, 15% Hispanic, 42% male, and had a mean age of 51 (SD = 10.3). Analysis of NEP by tertile demonstrated that younger age, lower income, and lower education were associated with unfavorable overall NEP (p trend <0.05 for each). After adjustment for potential confounders, including neighborhood deprivation, health insurance, disease burden and psychosocial factors, we found that individuals with more unfavorable perception of their physical environment were more likely to report lack of a usual source of care (p = 0.013). Individuals with more unfavorable perception of the neighborhood physical environment or greater neighborhood violence reported longer time periods since last routine visit (p = 0.001, p = 0.034 respectively). There was no relationship between perceived social cohesion and healthcare utilization. Using a multi-ethnic cohort, we found that NEP significantly associates with report of a usual source of care and time since last routine checkup. Our findings suggest that public health professionals should prioritize improving NEP since it may act as barrier to routine preventive healthcare and ideal health outcomes.

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“…MetS increases the risk of CVDs and type-2 diabetes mellitus and has been used worldwide to assess risk for CVDs in later life. Like CVDs, MetS is considered a multifactorial health problem that depends on genetic (8)(9)(10)(11), metabolic (12,13), behavioural (14)(15)(16), socio-economic (17), and environmental factors (18,19). In Peru, MetS prevalence varies between 15-55%, depending on gender, ethnicity, urbanisation and altitude (20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Improved cookstoves and the prevalence of metabolic syndrome in the rural Peruvian Andes: a quasi-experimental study

Sanchez-Samaniego

Mäusezahl

Cárcamo

et al. 2019

Preprint

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Background: Household air pollution increases the risk of non-communicable diseases, such as cardiovascular diseases and metabolic syndrome. This study hypothesised that the reduction of household air pollution through the installation of improved cookstoves is associated with the prevalence of metabolic syndrome. We compared the prevalence of metabolic syndrome between adults using open fire stoves and using improved cookstoves in high altitude provinces of Cajabamba and San Marcos in rural Peruvian Andes.Methods: This is a quasi experimental study nested within a randomised controlled trial (parent study) of 317 children randomised in four study arms. The parents study applied a 2x2 factorial design with three single intervention arms (improved cookstove (ICS), early child development (ECD) and Control) and one combined arm (ICS-ECD). This study was conducted 6-10 months after the ICS intervention was implemented and all parents of the 317 children in the parent study were eligible to participate. Ventilated improved cookstoves using biomass fuel were provided to intervention homes. All participants answered a 24-hour food recall and underwent a physical examination for metabolic syndrome diagnosis. Results: A total of 385 participants were allocated to two groups of improved cookstove users with 190 (112 women and 78 men) and open-fire stove users with 195 (123 women and 72 men). Metabolic syndrome was detected in 21% of all participants and more frequently in women than men (26% versus 13%). In women, the improved cookstove intervention was a protective factor for metabolic syndrome (Prevalence Ratio= 0.70 (0.46 to 1.08), p=0.11). In addition, PR increased with age in women. In both gender, significantly lower PR was found in participants living ≥2500 meters above sea level (PR=0.65 (0.42 to 1.00), p=0.051 in women; (PR=0.25 (0.07 to 0.71), p=0.009 in men).Conclusions: The improved cookstove intervention reducing household air pollution is associated with a lower prevalence of MetS in women users. In addition, residential altitude is an important risk factor for metabolic syndrome even in high altitude populations. Keywords: biomass fuel ventilated improved cookstove, household air pollution, metabolic syndrome, high altitude, Peru Trial registration: Trial registration number ISRCTN26548981 at www.srctn.com . Registered retrospectively, Jan. 15 2018.

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Access to Care and Cardiovascular Disease Prevention

Cited by 35 publications

References 28 publications

Cardiovascular Risk in Middle‐Aged and Older Immigrants: Exploring Residency Period and Health Insurance Coverage

Cardiovascular Risk in Middle‐Aged and Older Immigrants: Exploring Residency Period and Health Insurance Coverage

Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study

Improved cookstoves and the prevalence of metabolic syndrome in the rural Peruvian Andes: a quasi-experimental study

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