Association of health professional shortage areas and cardiovascular risk factor prevalence, awareness, and control in the Multi-Ethnic Study of Atherosclerosis (MESA).
Association of health professional shortage areas and cardiovascular risk factor prevalence, awareness, and control in the Multi-Ethnic Study of Atherosclerosis (MESA).
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DOI：
10.1161/circoutcomes.111.960922
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发表时间：
2011-09
期刊：
影响因子：
--
通讯作者：
Daviglus M
中科院分区：
文献类型：
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作者：
Allen NB;Diez-Roux A;Liu K;Bertoni AG;Szklo M;Daviglus M
生活在初级保健卫生专业人员短缺地区（PC-HPSA）的个人往往难以获得医疗护理；然而，之前没有研究探讨 PC-HPSA 居住与 CVD 危险因素患病率之间的关系。为了研究这个问题，作者使用了动脉粥样硬化多种族研究基线检查（2000-2002）的数据。结果包括糖尿病、高血压、高脂血症、吸烟和肥胖的患病率以及对糖尿病、高血压和高脂血症的认识和控制。使用多变量泊松模型来检查 PC-HPSA 居住与每个结果的独立关联。模型依次根据人口统计、文化适应、社会经济地位、获得医疗保健的机会和社区社会经济地位进行调整。与全国平均水平类似，16.7% 的 MESA 参与者居住在 PC-HPSA 中。在未经调整的分析中，PC-HPSA居民中糖尿病（14.8% vs 11.0%）、高血压（48.2% vs 43.1%）、肥胖（35.7% vs 31.1%）和吸烟（15.5% vs 12.1%）的患病率显着较高。对糖尿病、高血压或高脂血症的认识或控制没有显着差异。调整后，居住在 PC-HPSA 中与 CVD 危险因素的患病率、知晓率或控制率并不独立相关。这项研究表明，PC-HPSA 中 CVD 危险因素患病率的增加可以用其居民的人口和社会经济特征来解释。如果不首先解决造成医疗保健差异的其他因素，未来旨在增加初级保健医生数量的干预措施可能无法改善心血管风险。
Individuals living in primary care health professional shortage areas (PC-HPSA) often have difficulty obtaining medical care; however, no previous studies have examined association of PC-HPSA residence with prevalence of CVD risk factors. To examine this question, the authors used data from the Multi-Ethnic Study of Atherosclerosis baseline exam (2000–2002). Outcomes included the prevalence of diabetes, hypertension, hyperlipidemia, smoking and obesity as well as the awareness and control of diabetes, hypertension, and hyperlipidemia. Multivariable Poisson models were used to examine the independent association of PC-HPSA residence with each outcome. Models were sequentially adjusted for demographics, acculturation, socioeconomic status, access to health care and neighborhood socioeconomic status. Similar to the national average, 16.7% of MESA participants lived in a PC-HPSA. In unadjusted analyses, prevalence rates of diabetes (14.8% vs 11.0%), hypertension (48.2% vs 43.1%), obesity (35.7% vs 31.1%) and smoking (15.5% vs 12.1%) were significantly higher among residents of PC-HPSAs. There were no significant differences in the awareness or control of diabetes, hypertension, or hyperlipidemia. After adjustment, residence in a PC-HPSA was not independently associated with CVD risk factor prevalence, awareness or control. This study suggests that increased prevalence of CVD risk factors in PC-HPSAs are explained by the demographic and socioeconomic characteristics of their residents. Future interventions aimed at increasing the number of primary care physicians may not improve cardiovascular risk without first addressing other factors underlying healthcare disparities.