title: Health Professional Shortage Areas, insurance status, and cardiovascular disease prevention in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
abstract: Individuals with cardiovascular disease (CVD) living in Health Professional Shortage Areas (HPSA) may receive less preventive care than others. The Reasons for Geographic And Racial Differences in Stroke Study (REGARDS) surveyed 30,239 African American (AA) and White individuals older than 45 years of age between 2003-2007. We compared medication use for CVD prevention by HPSA and insurance status, adjusting for sociodemographic factors, health behaviors, and health status. Individuals residing in partial HPSA counties were excluded. Mean age was 64±9 years, 42% were AA, 55% were women, and 93% had health insurance; 2,545 resided in 340 complete HPSA counties and 17,427 in 1,145 non-HPSA counties. Aspirin, beta-blocker, and ACE-inhibitor use were similar by HPSA and insurance status. Compared with insured individuals living in non-HPSA counties, statin use was lower among uninsured participants living in non-HPSA and HPSA counties. Less medication use for CVD prevention was not associated with HPSA status, but less statin use was associated with lack of insurance.
authors.affiliation: University of Alabama at Birmingham, Division of Cardiovascular Diseases, USA. tmbrown@uab.edu
authors.forename: Todd M
authors.initials: TM
authors.lastname: Brown
authors.forename: Gaurav
authors.initials: G
authors.lastname: Parmar
authors.forename: Raegan W
authors.initials: RW
authors.lastname: Durant
authors.forename: Jewell H
authors.initials: JH
authors.lastname: Halanych
authors.forename: Martha
authors.initials: M
authors.lastname: Hovater
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Prineas
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.forename: Tandaw E
authors.initials: TE
authors.lastname: Samdarshi
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006306:Health Surveys; D006280:Health Workforce; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008507:Medically Underserved Area; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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