Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.
Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.
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DOI：
10.1007/s11764-020-00933-4
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Kern LM
中科院分区：
文献类型：
--
作者：
Pinheiro LC;Reshetnyak E;Safford MM;Nanus D;Kern LM
心血管疾病（CVD）是5年癌症幸存者的头号死因。幸存者看到许多供应商和协调不良可能会导致更差的CVD危险因素控制。我们试图确定整体幸存者和自测健康的碎片和CVD危险因素控制之间的关联。我们纳入了66岁以上的REGARDS参与者，他们：1）有癌症史; 2）报告糖尿病，高血压或高脂血症; 3）有连续的医疗保险。使用Bice-Boxerman指数（BBI）计算12个月的门诊护理碎片。我们确定了碎片化和心血管疾病风险因素之间的相关性，将“控制”定义为糖尿病的空腹血糖<126 mg/dL或非空腹血糖<200 mg/dL;高血压的血压<140/90 mm Hg;高脂血症的总胆固醇<240 mg/dL，低密度脂蛋白胆固醇<160 mg/dL或高密度脂蛋白胆固醇>40 mg/dL。1，002名癌症幸存者（癌症治疗后2年以上）的平均年龄为75岁，39%为女性，23%为黑人。在糖尿病（N=225）、高血压（N=660）和高脂血症（N=516）患者中，分别约有60%的CVD危险因素得到控制。总体而言，更分散的护理与更差的控制无关。然而，在健康状况极佳、非常好或良好的癌症幸存者中，更多的碎片与糖尿病控制可能性降低相关（OR 0.78，95%CI 0.61-0.99），调整混杂因素。在报告健康状况良好、非常好或良好的糖尿病癌症幸存者中，更分散的护理与更差的血糖控制相关。未观察到与高血压或高脂血症控制的相关性。减少碎片可能有助于糖尿病幸存者的血糖控制。
Cardiovascular disease (CVD) is the number one cause of death among 5-year cancer survivors. Survivors see many providers and poor coordination may contribute to worse CVD risk factor control. We sought to determine associations between fragmentation and CVD risk factor control among survivors overall and by self-rated health. We included REGARDS participants aged 66+ years who: 1) had a cancer history; 2) reported diabetes, hypertension or hyperlipidemia; and 3) had continuous Medicare coverage. Twelve month ambulatory care fragmentation was calculated using the Bice-Boxerman Index (BBI). We determined associations between fragmentation and CVD risk factors, defining “control” as fasting glucose <126 mg/dL or non-fasting glucose <200 mg/dL for diabetes; blood pressure <140/90 mm Hg for hypertension; and total cholesterol <240 mg/dL, low-density lipoprotein cholesterol <160 mg/dL, or high-density lipoprotein cholesterol >40 mg/dL for hyperlipidemia. The 1,002 cancer survivors (2+ years since cancer treatment) had mean age of 75 years, 39% were women, and 23% were Black. Among individuals with diabetes (N=225), hypertension (N=660), and hyperlipidemia (N=516), separately, approximately 60% had CVD risk factor control. Overall, more fragmented care was not associated with worse control. However, among cancer survivors with excellent, very good or good health, more fragmentation was associated with a decreased likelihood of diabetes control (OR 0.78, 95% CI 0.61–0.99), adjusting for confounders. More fragmented care was associated with worse glycemic control among cancer survivors with diabetes who reported excellent, very good, or good health. Associations were not observed for control of hypertension or hyperlipidemia. Reducing fragmentation may support glucose control among survivors with diabetes.
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影响因子：
20.1
作者：
North BJ;Sinclair DA
通讯作者：
Sinclair DA
影响因子：
5.7
作者：
Kern, Lisa M.;Safford, Monika M.;Abramson, Erika L.
通讯作者：
Abramson, Erika L.
影响因子：
5
作者：
Burgette, Lane F.;Reiter, Jerome P.
通讯作者：
Reiter, Jerome P.
影响因子：
39
作者：
Nyweide, David J.;Anthony, Denise L.;Fisher, Elliott S.
通讯作者：
Fisher, Elliott S.
影响因子：
5
作者：
ANDERSEN, RM
通讯作者：
ANDERSEN, RM