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

项目摘要/摘要 在美国，心血管死亡率的下降已经停滞不前，人们越来越担心这些 人口水平的趋势可能反映出低收入人群心血管危险因素和疾病负担的增加。 收入适龄劳动人口(18岁至)。然而，这些模式还没有很好地在 全国范围内。新冠肺炎大流行只会放大追踪心血管健康的迫切需要 低收入劳动年龄人口中的一部分。这场大流行导致了医疗保健的重大中断， 产生了巨大的溢出效应，包括失业和日益加深的财政困难，这已经 对低收入成年人的影响更大。这些变化可能会扩大医疗保险覆盖范围的不平等， 卫生保健的可获得性和可负担性，最终会在未来几年恶化心血管健康。在 疫情爆发后，政策制定者现在正在权衡是否扩大医疗保险计划，以增加 获得医疗保健的机会。了解这一政策变化对老年人心血管健康的潜在影响 低收入成年人可以为改善全国健康公平的联邦战略提供参考。在我们团队的基础上 在大数据集的链接和分析、流行病学和数据的应用方面的专业知识 计量经济学方法和卫生政策的评估，我们将检查心血管疾病的变化 低收入工作年龄成年人的风险因素、疾病和结局，评估 大流行病对卫生保健覆盖率、可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老年人心血管健康的潜在影响 这群人。为了做到这一点，我们将使用全国调查数据、州所有付款人和 国家医疗补助申请和疾控中心流行病学数据。在目标1中，我们将执行一项全国性分析， 决定心血管危险因素的流行、治疗和控制、急性 在低收入工作年龄成年人中，心血管事件和心血管死亡率在 大流行。在目标2中，我们将审查大流行是否与短期和长期有关 卫生保健覆盖面、可获得性和可负担性、心血管发病率和死亡率以及自我 使用中断时间序列分析报告低收入工作年龄成年人的健康状况。在《目标3》中，我们将 评估医疗保险在卫生保健可获得性和可负担性、筛查、治疗和控制方面的影响 低收入成年人心血管危险因素和自我报告健康的准实验研究 接近了。这项研究将促进我们对心血管发病率变化的理解和 低收入工作年龄成年人在疫情爆发前后的死亡率，并提供了关于 扩大医疗保险对医疗保健可获得性、可负担性和心血管健康的影响 人口。心血管疾病仍然是美国的主要死亡原因，我们的工作最终将 告知公共卫生和政策战略，以改善心血管结果--并在全国范围内实现公平。

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.