Clinical research study
Health Insurance and Cardiovascular Disease Risk Factors

https://doi.org/10.1016/j.amjmed.2010.02.013Get rights and content

Abstract

Background

Compared with those with health insurance, the uninsured receive less care for chronic conditions, such as hypertension and diabetes, and experience higher mortality.

Methods

We investigated the relations of health insurance status to the prevalence, treatment, and control of major cardiovascular disease risk factors—hypertension and elevated low-density lipoprotein (LDL) cholesterol—among Framingham Heart Study (FHS) participants in gender-specific, age-adjusted analyses. Participants who attended the seventh Offspring cohort examination cycle (1998-2001) or the first Third Generation cohort examination cycle (2002-2005) were studied.

Results

Among 6098 participants, 3.8% were uninsured at the time of the FHS clinic examination and ages ranged from 19 to 64 years. The prevalence of hypertension and elevated LDL cholesterol was similar for the insured and uninsured; however, the proportion of those who obtained treatment and achieved control of these risk factors was lower among the uninsured. Uninsured men and women were less likely to be treated for hypertension with odds ratios for treatment of 0.19 (95% confidence interval [CI], 0.07-0.56) for men and 0.31 (95% CI, 0.12-0.79) for women. Among men, the uninsured were less likely to receive treatment or achieve control of elevated LDL cholesterol than the insured, with odds ratios of 0.12 (95% CI, 0.04-0.38) for treatment and 0.17 (95% CI, 0.05-0.56) for control.

Conclusion

The treatment and control of hypertension and hypercholesterolemia are lower among uninsured adults. Increasing the proportion of insured individuals may be a means to improve the treatment and control of cardiovascular disease risk factors and to reduce health disparities.

Section snippets

Study Population

The FHS is an observational study that began in 1948 when an original study cohort was enrolled. The children and spouses of children of the Original cohort were enrolled in the Offspring cohort, beginning in 1971.11 The Third Generation cohort, composed of children of Offspring cohort participants, was enrolled starting in 2002.12 Data from the 3539 participants in the Offspring cohort's seventh examination cycle (1998-2001) and 4095 participants in the first examination cycle for the Third

Baseline Clinical Characteristics

Women comprised 53.5% of the study sample. Five percent of men and 3% of women were uninsured; 59% of the uninsured were men. Mean systolic and diastolic blood pressures for the insured and uninsured were 122/78 and 121/77 mm Hg for men and 116/73 and 118/73 mm Hg for women, respectively (Table 1). For men, total cholesterol and LDL cholesterol values were significantly higher among the uninsured at 200 and 126 mg/dL compared with 194 and 121 mg/dL for the insured, respectively (P = .01 and P = 

Discussion

The proportions of those with treated and controlled major cardiovascular disease risk factors were considerably lower in uninsured compared with insured individuals. This was most notable for treatment and control of hypertension and elevated LDL cholesterol in men and for hypertension treatment in women. Whereas the lower rate of hypertension control in the uninsured has been demonstrated,5 the finding that the proportion of controlled hypercholesterolemia also is significantly lower in

Conclusions

Our investigation emphasizes the relations between insurance status and cardiovascular disease risk factor prevalence, treatment, and control. Although we studied a highly insured population—less than 5% of FHS participants were uninsured compared with more than 15% in the general population1—multiple noteworthy differences were identified. More research is needed to determine whether the associations we observed are replicated in different samples with a greater proportion of uninsured

References (24)

  • O.K. Duru et al.

    Health insurance status and hypertension monitoring and control in the United States

    Am J Hypertens

    (2007)
  • M. Feinleib et al.

    The Framingham Offspring StudyDesign and preliminary data

    Prev Med

    (1975)
  • C. DeNavas-Walt et al.

    U.S. Census Bureau, Current Population Reports, P60-236, Income, Poverty, and Health Insurance Coverage in the United States: 2008

    (2009)
  • J.E. DeVoe et al.

    Receipt of preventive care among adults: insurance status and usual source of care

    Am J Public Health

    (2003)
  • A. Davidoff et al.

    Uninsured Americans with Chronic Health Conditions: Key Findings from the National Health Interview Survey

    (2005)
  • J.M. McWilliams et al.

    Health insurance coverage and mortality among the near-elderly

    Health Aff (Millwood)

    (2004)
  • A. Fowler-Brown et al.

    Risk of cardiovascular events and death—does insurance matter?

    J Gen Intern Med

    (2007)
  • J.Z. Ayanian et al.

    Undiagnosed hypertension and hypercholesterolemia among uninsured and insured adults in the Third National Health and Nutrition Examination Survey

    Am J Public Health

    (2003)
  • E. Moy et al.

    Access to hypertensive careEffects of income, insurance, and source of care

    Arch Intern Med

    (1995)

  • An Act Providing Access to Affordable, Quality Accountable Health CareChapter 58 of the Acts of 2006

  • C. DeNavas-Walt et al.

    Income, Poverty, and Health Insurance Coverage in the United States: 2006

  • G.L. Splansky et al.

    The Third Generation Cohort of the National Heart, Lung, and Blood Institute's Framingham Heart Study: design, recruitment, and initial examination

    Am J Epidemiol

    (2007)

    • Cited by (66)

    • Longitudinal effects of lipid indices on incident cardiovascular diseases adjusting for time-varying confounding using marginal structural models: 25 years follow-up of two US cohort studies

      2022, Global Epidemiology

    • Antibiotic use numeracy: Developing the infectious numeracy test (INT)

      2022, Research in Social and Administrative Pharmacy

    • Metabolic and inflammatory risk reduction in response to lipid-lowering and lifestyle modification in the medically underserved individuals

      2021, American Journal of Preventive Cardiology

    • Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities A Systematic Review and Meta-Analysis

      2024, JAMA Network Open

    • Advancing Cardiovascular Risk Assessment with Artificial Intelligence: Opportunities and Implications in North Carolina

      2024, North Carolina Medical Journal

    • Predictors of Hypertension among Indian Women of Reproductive Age Group: An Analysis from NFHS-5 Data

      2023, National Journal of Community Medicine
    View all citing articles on Scopus

    Funding: The Framingham Heart Study is funded through National Institutes of Health contract N01-HC-25195.

    Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

    View full text
    Published by Excerpta Medica Inc.