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

项目概要/摘要 在美国，心血管疾病死亡率的下降已经停滞，人们越来越担心， 人口水平的趋势可能反映了心血管危险因素和疾病负担的增加， 有收入的工作年龄成年人（18至64岁）。然而，这些模式还没有得到很好的表征， 全国范围内。2019冠状病毒病大流行只会放大跟踪心血管健康的迫切需要 低收入劳动年龄人口。这一流行病导致卫生保健受到严重干扰， 造成了巨大的溢出效应，包括失业和日益严重的财政困难， 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面的不平等， 医疗保健的可获得性和可负担性，最终会在未来几年内恶化心血管健康。在 在大流行之后，政策制定者正在考虑是否扩大医疗保险计划， 获得医疗保健。了解这一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战略提供信息，以改善全国的健康公平。基于我们团队的 在大型数据集的联系和分析，流行病学和 计量经济学方法和卫生政策的评估，我们将研究心血管疾病的变化， 风险因素、疾病和低收入工作年龄成年人的结果，评估 大流行病对卫生保健覆盖面、可及性和可负担性以及心血管病发病率的影响， 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。要做到这一点，我们将使用一个独特的组合，全国调查数据，国家所有付款人， 国家医疗补助索赔和CDC流行病学数据。在目标1中，我们将进行国家分析， 确定是否流行，治疗和心血管危险因素的控制，急性 心血管事件和心血管死亡率在低收入工作年龄的成年人中增加， 大流行病在目标2中，我们将研究大流行是否与短期和长期 卫生保健覆盖率、可及性和可负担性、心血管发病率和死亡率以及自我保健的变化 使用中断时间序列分析报告低收入工作年龄成人的健康状况。在目标3中，我们 评估医疗保险对医疗保健可及性和可负担性的影响，筛查，治疗和控制 心血管危险因素，以及低收入成年人自我报告的健康状况， 接近。这项研究将促进我们对心血管发病率变化的理解， 在大流行病之前和之后，低收入工作年龄成年人的死亡率，并提供重要的见解， 扩大医疗保险对医疗保健可及性、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死亡的主要原因，我们的工作将最终 为公共卫生和政策战略提供信息，以改善全国范围内的心血管结局和公平性。

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.