Spatiotemporal and Demographic Trends and Disparities in Cardiovascular Disease Among Older Adults in the United States Based on 181 Million Hospitalization Records

Abstract

BackgroundThe US population is aging, with concurrent increases in cardiovascular disease (CVD) burdens; however, spatiotemporal and demographic trends in CVD incidence in the US elderly have not been investigated in detail. This study aims to characterize trends from 1991 to 2014 in CVD hospitalizations among US Medicare beneficiaries, aged 65+ years, by single year of age/sex/race/state using records from the US Centers for Medicare & Medicaid, covering 98% of older Americans.Methods and ResultsWe abstracted 181 202 758 US Centers for Medicare & Medicaid hospitalization records indicating CVD in any of 10 diagnosis codes; tabulated total cases of CVD by sex, age, race, state, and calendar year (1991–2014); and normalized hospitalization counts to standardize over data batches. Stratum‐specific hospitalization rates were calculated using US Centers for Medicare & Medicaid records and US Census population counts; a cubic polynomial function was fit to year‐specific distributions of rates by single year of age. Nationwide, CVD‐related hospitalization rates increased from 1991 to 2014. Differences between hospitalization rates at age 65 and 66 years, representing magnitude of healthcare deferral until Medicare onset, increased by 7.49 per 100 people 1991 to 2006 overall, and were largest among blacks and Native Americans. Rates of CVD hospitalizations were consistently highest in the Midwest/Deep South. Evidence of misclassification of race/ethnicity in US Centers for Medicare & Medicaid hospitalization records in the 1990s was noted.ConclusionsTrends in CVD‐related hospitalization rates among older Americans highlight the essential need for targeted policies to reduce CVD burdens, to improve reporting of race/ethnicity in large administrative databases, and to enhance access to affordable healthcare.

Health service inequalities during the COVID-19 pandemic among elderly people living in large urban and non-urban areas in Florida, US

“…Our findings confirmed deficiency in providing health care to elderly people living outside of large or medium metropolitan areas (Casper et al, 2016;Singh et al, 2019). Elderly people living in small towns or rural areas were known for lacking adequate health care (Odoi, Nagle, Roberson, & Kintziger, 2019).…”

“…Furthermore, our findings confirmed deficiencies in providing health care to elderly people living outside of large or medium metropolitan areas (Casper et al 2016; Singh et al 2019). Health care facilities in the US were mostly concentrated in large cities.…”

Measures of Financial Hardship From Health Care Expenses Among Families With a Member With Atherosclerotic Cardiovascular Disease in the US

“…These observations may be partially explained by the phenomenon of the deferral of cardiovascular disease medical services by uninsured or underinsured individuals until the onset of Medicare. 18 Furthermore, younger individuals are more likely to have debt, including student loans and home mortgages, 19 which may contribute to greater subjective financial hardship. The higher odds of subjective financial hardship than objective financial hardship among people who were uninsured compared with people with private insurance may also be owing to fewer visits to physicians among participants who are uninsured, 20 which can be followed by greater deferral of care and less objective financial hardship.…”

Health service inequalities during the COVID-19 pandemic among elderly people living in large urban and non-urban areas in Florida, USA

“…Furthermore, our findings confirmed deficiencies in providing health care to elderly people living outside of large or medium metropolitan areas. 30,31 Health-care facilities in the United States were mostly concentrated in large cities. Elderly people living in small metropolitan or rural areas were known for lacking adequate health care.…”