Economics and Heart Care

By Jane Farrell

Lower–income adults in the United States were significantly less likely to be screened for cardiovascular disease (CVD) or receive counseling for CVD risk factors, according to research presented in May 2021 at the American Heart Association’s (AHA} Quality of Care & Outcomes Research Scientific Sessions 2020. The virtual conference, eld May 15-16, is a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, health care professionals and policymakers.

Heart-health screenings, including routine blood pressure and cholesterol checks, and counseling to improve diet, increase exercise or smoking cessation are important for lowering the risk for CVD. For decades, studies have confirmed markers of socioeconomic status such as income are associated with cardiovascular disease; however, the association between income level and the utilization of CVD preventive services is not well understood.

“With the goal of encouraging clinicians and health care providers to be aware of health disparities, we set out to determine how patients at different income levels utilize services to prevent cardiovascular disease,” said lead study author Andi Shahu, M.D., M.H.S., an internal medicine resident physician at The Johns Hopkins Hospital in Baltimore.

Using patient data from the nationally representative Medical Expenditure Panel Survey (2006-2015), researchers included 32,862 adults with diagnosed CVD and 185,081 adults with no CVD diagnosis. Of the total, 36% of individuals were in the “high income” category (400% or more of the federal poverty level [FPL]); 29% were in the “middle income” category (200%-400% of the FPL); 16% were in the “low income” category (125%-200% of FPL); and 19% were in the “poor/very low income” category (<125% of FPL).

Among the statistically significant results, researchers found when compared with “high income” participants:

Participants without CVD who were categorized as “low income” were 58% less likely to get their cholesterol checked within the last five years and 55% less likely to get their blood pressure checked within the past two years;

Participants without CVD who were categorized as “poor/very low income” were 64% less likely to have had their cholesterol checked within the last five years and 59% less likely to have had their blood pressure checked within the past two years;

Participants with CVD who were categorized as “low income” were 66% less likely to get their cholesterol checked within the last five years or their blood pressure checked within the past two years; and

Participants with CVD who were categorized as “poor/very low income” were 67% less likely to have had their cholesterol checked within the last five years and 68% less likely to have had their blood pressure checked within the past two years;

“The significant gap in access to preventive care among lower income populations is incredibly worrisome. Preventive care, including regular cholesterol screenings and blood pressure monitoring, are essential to reducing heart disease and stroke,” said Shahu. “Additionally, socioeconomic disparities are often made even worse during times of crisis, such as the current COVID-19 pandemic, because vulnerable populations are often disproportionately impacted both medically and economically. The American people need to know these types of disparities cannot be fixed in the doctor’s office alone. They must be addressed using city-level, state-level or even nationwide interventions, and public health policies must align to support these interventions.” For more information on other issues, click here to visit the agency’s AHA website.