Clinical Investigation
Outcomes, Health Policy, and Managed Care
Beyond insurance coverage: Usual source of care in the treatment of hypertension and hypercholesterolemia. Data from the 2003-2006 National Health and Nutrition Examination Survey

https://doi.org/10.1016/j.ahj.2010.04.013Get rights and content

Background

Expanding insurance coverage, while necessary, may not be sufficient to ensure high-quality care for adults with cardiovascular disease. We sought to examine the association between having a usual source of care (USOC) and receiving medication treatment of hypertension and hypercholesterolemia.

Methods

Using the 2003-2006 National Health and Nutrition Examination Survey, we categorized USOC (a place to go when sick or need medical advice) and insurance status in adults ≥35 years old with an indication for medication treatment of hypertension (n = 3,142) and hypercholesterolemia (n = 1,134), determined using the Joint National Committee 7 and Adult Treatment Panel III recommendations, respectively. Multivariable logistic regression modeling was used to determine the independent effect of USOC on receiving treatment of hypertension and hypercholesterolemia, controlling for age, sex, race/ethnicity, insurance status, and comorbidities. Separate multivariable models were examined stratified by insurance status.

Results

Among subjects with an indication for treatment of hypertension and hypercholesterolemia, 32.4% and 42.0% were untreated, respectively. When compared with adults with a USOC, adults without a USOC were more likely to be untreated for hypertension (adjusted prevalence ratio [aPR] 2.43, 95% CI 1.88-2.85) and hypercholesterolemia (aPR 1.79, 95% CI 1.31-2.13). In stratified analyses among subjects with insurance, no USOC remained associated with being untreated (hypertension, aPR 2.58, 95% CI 1.88-3.08; hypercholesterolemia, aPR 1.65, 95% CI 0.97-2.18).

Conclusions

Absence of a USOC was associated with being untreated for hypertension and hypercholesterolemia, even among individuals with insurance, suggesting that efforts to improve chronic disease management should also facilitate access to a regular source of care.

Section snippets

Study design and data source

Data come from the National Health and Nutrition Examination Survey (NHANES). Conducted by the National Center for Health Statistics, NHANES collects detailed health and nutritional data on a nationally representative, multistage probability sample of the noninstitutionalized civilian population of the United States. NHANES includes both an in-home interview and a clinical examination at a mobile examination center (MEC). A subsample of respondents, selected at random with a specified sampling

Results

Among adults ≥35 years old, 46.5% had an indication for antihypertension therapy (3,142 individuals; representing approximately 58.79 million persons) and 40.0% had an indication for an LLM (1,134 individuals; representing approximately 50.6 million persons). The proportion of adults who were untreated was high in both the hypertension (32.4%) and hypercholesterolemia (42.0%) groups.

Most adults reported having a USOC (hypertension group 93.1%, hypercholesterolemia group 93.6%), comparable to

Discussion

In this recent, nationally representative sample, not having a USOC is independently associated with being untreated for 2 common cardiovascular risk factors, hypertension and hypercholesterolemia. This effect was observed among adults with and without insurance coverage. These findings support our hypothesis that USOC and insurance coverage have independent effects on the treatment of hypertension and hypercholesterolemia and suggest the possibility that having a USOC might promote better

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