title: Health Insurance Status as a Barrier to Ideal Cardiovascular Health for U.S. Adults: Data from the National Health and Nutrition Examination Survey (NHANES).
abstract: BACKGROUND
  Little is known about the association between cardiovascular (CV) health and health insurance status. We hypothesized that U.S. adults without health insurance coverage would have a lower likelihood of ideal cardiovascular health.
  
  
  RESULTS
  Using National Health and Nutrition Examination Survey (NHANES) data from 2007-2010, we examined the relationship between health insurance status and ideal CV health in U.S. adults aged ≥19 years and <65 (N = 3304). Ideal CV health was defined by the American Heart Association (AHA) as the absence of clinically manifested CV disease and the simultaneous presence of 6-7 "ideal" CV health factors and behaviors. Logistic regression modeling was used to determine the relationship between health insurance status and the odds of ideal CV health. Of the U.S. adult population, 5.4% attained ideal CV health, and 23.5% were without health insurance coverage. Those without health insurance coverage were more likely to be young (p<0.0001), male (p<0.0001), non-white (p<0.0001), with less than a high school degree (p<0.0001), have a poverty-to-income ratio less than 1 (p<0.0001) and unemployed (p<0.0001) compared to those with coverage. Lack of health insurance coverage was associated with a lower likelihood of ideal CV health; however, this relationship was attenuated by socioeconomic status.
  
  
  CONCLUSIONS
  U.S. adults without health insurance coverage are less likely to have ideal CV health. Population-based strategies and interventions directed at the community-level may be one way to improve overall CV health and reach this at-risk group.
authors.affiliation: Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Michael A
authors.initials: MA
authors.lastname: McClurkin
authors.affiliation: Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Leah Rae
authors.initials: LR
authors.lastname: Yingling
authors.affiliation: Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
authors.forename: Colby
authors.initials: C
authors.lastname: Ayers
authors.affiliation: Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cooper-McCann
authors.affiliation: Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Visakha
authors.initials: V
authors.lastname: Suresh
authors.affiliation: University of Maryland, College Park, Maryland, United States of America.
authors.forename: Ann
authors.initials: A
authors.lastname: Nothwehr
authors.affiliation: Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Debbie S
authors.initials: DS
authors.lastname: Barrington
authors.affiliation: Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America.
authors.forename: Tiffany M
authors.initials: TM
authors.lastname: Powell-Wiley
mesh_terms: D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States