Cardiovascular Health of Low-Income Working-Age Adults in the US: Health Care Access, Policy, and the Pandemic

美国低收入工作年龄成年人的心血管健康：医疗保健获取、政策和大流行

• 批准号: 10502097
• 负责人: Rishi Kumar Wadhera
• 金额: $ 80.06万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10502097
• 关键词: Acute; Adult; Age; Behavioral Risk Factor Surveillance System; Black race; COVID-19 pandemic; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Data; Data Set; Death Rate; Disease; Disease Outcome; Eligibility Determination; Enrollment; Epidemiology; Evaluation; Event; Financial Hardship; Goals; Health; Health Insurance; Health Policy; Health Services Accessibility; Healthcare; Heart failure; Hospitalization; Incidence; Income; Insurance Carriers; Insurance Coverage; Interruption; Left; Link; Low income; Medicaid; Medical; Medicare; Methods; Morbidity - disease rate; Myocardial Infarction; National Health and Nutrition Examination Survey; Outcome; Patient Self-Report; Pattern; Persons; Policies; Population; Prevalence; Public Health; Publishing; Quasi-experiment; Research; Risk Factors; Rural Community; Source; Stroke; Subgroup; Surveys; Time; Time Series Analysis; Unemployment; United States; Vulnerable Populations; Work; aging population; base; cardiovascular disorder epidemiology; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; care outcomes; econometrics; epidemiologic data; experience; genetic linkage analysis; health care availability; health equity; health inequalities; improved; insight; large datasets; mortality; pandemic disease; population health; programs; public health insurance; response; screening; social health determinants; socioeconomics; trend

PROJECT SUMMARY/ABSTRACT In the United States, declines in cardiovascular mortality have stalled, and there is growing concern that these population-level trends may reflect an increase in the burden of cardiovascular risk factors and disease in low- income working-age adults (18 to 64 years). However, these patterns have not been well characterized on a national scale. The COVID-19 pandemic has only magnified the critical need to track the cardiovascular health of the low-income working-age population. The pandemic has led to substantial disruptions in health care, and created enormous spillover effects, including unemployment and deepening financial hardship, which have fallen more heavily on low-income adults. These changes may widen inequities in health insurance coverage, health care access, and affordability, and ultimately, worsen cardiovascular health for years to come. In the wake of the pandemic, policymakers are now weighing whether to expand the Medicare program to increase access to health care. Understanding the potential effects of this policy change on the cardiovascular health of low-income adults could inform federal strategies to improve health equity nationwide. Building on our team’s expertise in the linkage and analysis of large datasets, the application of epidemiological and econometric methods, and the evaluation of health policies, we will examine changes in cardiovascular risk factors, disease, and outcomes in low-income working-age adults, assess the impact of the pandemic on health care coverage, access, and affordability as well as cardiovascular morbidity and mortality, and determine the potential effects of expanding Medicare on the cardiovascular health of this population. To do so, we will use a unique combination of national survey data, state all-payer and national Medicaid claims, and CDC epidemiological data. In Aim 1, we will perform a national analysis that determines whether the prevalence, treatment, and control of cardiovascular risk factors, incidence of acute cardiovascular events, and cardiovascular mortality were increasing in low-income working-age adults prior to the pandemic. In Aim 2, we will examine whether the pandemic was associated with short- and long-term changes in health care coverage, access, and affordability, cardiovascular morbidity and mortality, and self- reported health in low-income working-age adults using interrupted time series analyses. In Aim 3, we will evaluate the effects of Medicare on health care access and affordability, the screening, treatment and control of cardiovascular risk factors, and self-reported health in low-income adults using quasi-experimental approaches. This research will advance our understanding of changes in cardiovascular morbidity and mortality among low-income working-age adults, before and after the pandemic, and provide critical insights on the implications of expanding Medicare on health care access, affordability, and cardiovascular health for this population. Cardiovascular disease remains the leading cause of death in the US, and our work will ultimately inform public health and policy strategies to improve cardiovascular outcomes – and equity – nationwide.

项目摘要/摘要 在美国，心血管死亡率下降已经停滞不前，人们越来越担心这些 人口水平的趋势可能反映出低 - 低 - 收入工作年龄成年人（18至64岁）。但是，这些模式尚未得到很好的表征 国家规模。 COVID-19大流行只扩大了跟踪心血管健康的关键需求 低收入工人年龄的人口。大流行导致医疗保健的大量中断，并 造成了巨大的Spilover效应，包括失业和加深财务困难， 在低收入成年人身上更加严重。这些变化可能会扩大健康保险覆盖范围的不平等， 医疗保健访问和负担能力，以及最终在未来几年内更糟的心血管健康。在 大流行的唤醒，政策制定者现在正在加权是否扩大医疗保险计划以增加 获得医疗保健。了解该政策变化对心血管健康的潜在影响 低收入成年人可以为联邦策略提供依据，以改善全国的健康公平。在我们团队的基础上建立 大型数据集的链接和分析方面的专业知识，流行病学和 经济方法以及对健康政策的评估，我们将检查心血管的变化 低收入工作年龄成年人的危险因素，疾病和结果，评估 医疗保健覆盖范围，获得性和可负担性以及心血管发病率和 死亡率，并确定扩大医疗保险对心血管健康的潜在影响 这个人口。为此，我们将使用国家调查数据，州所有付款人和 国家医疗补助索赔和CDC流行病学数据。在AIM 1中，我们将进行全国分析， 确定心血管危险因素的患病率，治疗和控制是否存在 在低收入的成年人中，心血管事件和心血管死亡率正在增加 大流行。在AIM 2中，我们将检查大流行是否与短期和长期相关 医疗保健覆盖范围，访问和负担能力的变化，心血管发病率和死亡率以及自我 使用中断的时间序列分析报告了低收入工作年龄成年人的健康状况。在AIM 3中，我们将 评估Medicare对医疗保健访问和可用性，筛查，治疗和控制的影响 使用准实验的低收入成年人的心血管危险因素和自我报告的健康 方法。这项研究将提高我们对心血管发病率变化的理解和 大流行前后，低收入工作年龄成年人的死亡率，并提供有关关键见解 扩大医疗保险对医疗保健访问，负担能力和心血管健康的影响 人口。心血管疾病仍然是美国死亡的主要原因，我们的工作最终将 为公共卫生和政策策略提供信息，以改善全国的心血管成果和公平性。