Abstract 23: Income Disparity and Utilization of Cardiovascular Preventive Care Services in the Medical Expenditure Panel Survey (MEPS)

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Andi Shahu ◽  
Victor Okunrintemi ◽  
Martin Tibuakuu ◽  
Safi U Khan ◽  
Martha Gulati ◽  
...  
Keyword(s):  
Low Income ◽  
Medical Expenditure Panel Survey ◽  
Preventive Services ◽  
High Income ◽  
Medical Expenditure ◽  
Panel Survey ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Middle Income ◽  
Income Groups

Background: Socioeconomic markers such as income level are associated with cardiovascular disease (CVD). However, the associations between income and utilization of CVD preventive services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without established CVD are less well understood. Methods: We used data from the nationally representative Medical Expenditure Panel Survey (2006-2015). We included adults (≥18 years old) and divided the sample population into 2 groups: those with CVD (defined by self-reported and/or ICD9 diagnosis of CVD [coronary artery disease, stroke, heart failure, cardiac dysrhythmias and/or peripheral arterial disease]) and those without CVD. Participant responses were recorded by telephone survey. Additional information on health care utilization was collected from physicians, hospitals, and pharmacies. We categorized participants as high income (400% of federal poverty level [FPL]), middle income (200-400% of FPL), low income (125-200% of FPL) and poor/very low income (<125% of FPL). We used logistic regression to compare likelihood of utilizing or receiving certain CVD risk preventive services among participants in different income groups, adjusting for demographics, comorbidities and other socioeconomic factors. Results: We included 185,081 participants without CVD (representing 194.6 million US adults without CVD, 48% female) and 32,862 participants with CVD (representing 37 million U.S. adults with CVD); 36% of individuals with CVD were in the high income category, 29% were middle income, 16% and 19% were in the low and poor/very low income group, respectively. Compared with high income adults, adults with low and poor/very low income were less likely to have cholesterol levels or blood pressure checked and receive counseling about diet modifications, exercise, or smoking cessation, regardless of CVD status ( Table ). Conclusion: Poor/very low income adults were much less likely to be screened for CVD risk factors or receive counseling for prevention of CVD than high income adults. More work must be done to reduce disparities in access to and utilization of CVD preventive services among adults in different income groups.

scholarly journals Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among US Adults: Trends From 2008 to 2017, the Medical Expenditure Panel Survey

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Victor Okunrintemi ◽  
Martin Tibuakuu ◽  
Salim S. Virani ◽  
Laurence S. Sperling ◽  
Annabelle Santos Volgman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Age At Diagnosis ◽  
Panel Survey ◽  
Cvd Risk Factors ◽  
Cvd Risk

Background Sex differences in the trends for control of cardiovascular disease (CVD) risk factors have been described, but temporal trends in the age at which CVD and its risk factors are diagnosed and sex‐specific differences in these trends are unknown. Methods and Results We used the Medical Expenditure Panel Survey 2008 to 2017, a nationally representative sample of the US population. Individuals ≥18 years, with a diagnosis of hypercholesterolemia, hypertension, coronary heart disease, or stroke, and who reported the age when these conditions were diagnosed, were included. We included 100 709 participants (50.2% women), representing 91.9 million US adults with above conditions. For coronary heart disease and hypercholesterolemia, mean age at diagnosis was 1.06 and 0.92 years older for women, compared with men, respectively (both P <0.001). For stroke, mean age at diagnosis for women was 1.20 years younger than men ( P <0.001). The mean age at diagnosis of CVD risk factors became younger over time, with steeper declines among women (annual decrease, hypercholesterolemia [women, 0.31 years; men 0.24 years] and hypertension [women, 0.23 years; men, 0.20 years]; P <0.001). Coronary heart disease was not statistically significant. For stroke, while age at diagnosis decreased by 0.19 years annually for women ( P =0.03), it increased by 0.22 years for men ( P =0.02). Conclusions The trend in decreasing age at diagnosis for CVD and its risk factors in the United States appears to be more pronounced among women. While earlier identification of CVD risk factors may provide opportunity to initiate preventive treatment, younger age at diagnosis of CVD highlights the need for the prevention of CVD earlier in life, and sex‐specific interventions may be needed.

Abstract 14212: Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among Us Adults; Trends From 2008-2017, the Medical Expenditure Panel Survey

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Martin Tibuakuu ◽  
Salim S Virani ◽  
Laurence Sperling ◽  
Annabelle S Volgman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Sex Differences ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Age At Diagnosis ◽  
Panel Survey ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Us

Introduction: Although data up to 2016 suggests that mortality from cardiovascular disease (CVD) in the US appears to be on a decreasing trend, there is evidence of stagnation in progress among young adults, especially women. Sex differences in the trends for control of CVD risk factors have been described, but the temporal trends in the age at which CVD and its risk factors are diagnosed in the US, and whether there are sex-specific differences in these trends is unknown. Methods: We used the Medical Expenditure Panel Survey (MEPS) 2008-2017, a nationally representative sample of the US population. Individuals ≥18 years, with a diagnosis of hypercholesterolemia, hypertension, coronary heart disease (CHD) or stroke and reported the age at which these conditions were diagnosed were included. The trend in the age at diagnosis was calculated from the annual change overall and by sex, using a linear regression model. Results: There were 100,709 participants (50.2% women), representing 91.9 million US adults with the above disease conditions. The mean age at diagnosis of CVD risk factors has decreased over time, with steeper declines among women [(Hypercholesterolemia: women - annual decrease of 0.31 years, men-annual decrease of 0.24 years, all Ps<0.001); (Hypertension: women - annual decrease of 0.23 years, men - annual decrease of 0.20 years, all Ps<0.001); the annual decrease in the age at diagnosis for CHD was not statistically significant. For stroke, while the age at diagnosis decreased by 0.19 years annually for women (p=0.03), it increased by 0.22 years annually for men (p=0.02) Conclusion: The decreasing trend in the age at diagnosis for CVD and its risk factors in the US appears to be more pronounced among women. While earlier identification of CVD risk factors may provide an opportunity to initiate preventive treatment, younger age at diagnosis of CVD highlights the need for the prevention of CVD at the earliest opportunity and sex-specific interventions may be needed.

scholarly journals Macroeconomic Impact of 2008 Financial Crisis on Countries by Income Groups

2017 ◽  
Vol 2 (4) ◽  
pp. 57
Author(s):  
Erkan DEMIRBAS
Keyword(s):  
Low Income ◽  
High Income ◽  
Middle Income ◽  
Monetary Policies ◽  
Development Indicators ◽  
Income Groups ◽  
The Us ◽  
Macroeconomic Indicators ◽  
Macroeconomic Impact ◽  
Weak Growth

<p>The aim of this study is to analyze the effect of the US mortgage crisis on macroeconomic indicators by considering classification of countries by income groups. Using the data of World Development Indicators prepared by World Bank, countries are classified in four groups respectively low-income economies, lower-middle-income and upper-middle-income and high-income economies. For these groups of countries the data of macroeconomic indicators such as economic growth, employment, inflation, export, from 2005 to 2015 are examined. Obtained results show that group of high income countries have not just been heavily affected from 2008 crisis, but also facing problem of weak growth and risk of deflation, whereas middle income economies have been affected from declining commod­ity prices. Present conditions are required to initiate proactive fiscal and monetary policies in the world.</p>

scholarly journals The temporal evolution of income polarization in Canada’s largest CMAs

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0251430
Author(s):  
Lazar Ilic ◽  
M. Sawada
Keyword(s):  
Low Income ◽  
Spatial Clustering ◽  
High Income ◽  
Fragmented Landscape ◽  
Landscape Mosaic ◽  
Middle Income ◽  
Income Groups ◽  
Income Polarization ◽  
Low Income Groups ◽  
Using Data

Income polarization is a pressing issue which is increasingly discussed by academics and policymakers. The present research examines income polarization in Canada’s eight largest Census Metropolitan Areas (CMAs) using data at the census-tract (CT) level between 1971 and 2016. Generally, there are significant decreasing trends in the middle-income population with simultaneously increasing trends in low-income groups. The high-income groups have been relatively stable with fewer significant increasing population trends. Using conventional mapping and cartograms, patterns of the spatial evolution of income inequality are illustrated. Every CMA examined contains an increasing trend of spatial fragmentation at the patch level within each CMA’s landscape mosaic. The results of a spatial autocorrelation analysis at the sub-patch, CT level, exhibit significant spatial clustering of high-income CTs as one process that dominates the increasingly fragmented landscape mosaic.

Abstract 13: Economic Impact of Moderate-vigorous Physical Activity Among Those with and without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Javier Valero-Elizondo ◽  
Joseph A Salami ◽  
Chukwuemeka U Osondu ◽  
Adnan Younus ◽  
Alejandro Arrieta ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Medical Expenditure Panel Survey ◽  
Vigorous Physical Activity ◽  
Medical Expenditure ◽  
Panel Survey ◽  
Cvd Risk ◽  
Vigorous Exercise ◽  
Physically Active ◽  
Artery Disease

Background: Physical activity (PA) is an established factor for favorable cardiovascular disease (CVD) outcomes and quality of life. However, to date little is available on PA’s independent impact on healthcare cost. In this study, we aimed to estimate this effect on medical expenditure from a nationally representative cohort with and without CVD. Methods: The 2012 Medical Expenditure Panel Survey data was analyzed. Our study population was limited to non-institutionalized adults ≥ 40 years of age. Variables of interest were CVD (coronary artery disease, stroke, heart failure, dysrhythmias or peripheral artery disease), modifiable risk factors (MRF; hypertension, diabetes mellitus, hypercholesterolemia, smoking, and/or obesity), and PA (dichotomous variable: defined as moderate-vigorous exercise of ≥ 30 minutes, 5 times/week). Two-part econometric models were utilized to study cost data; a generalized linear model with gamma distribution and link log was used to assess expenditures per capita, taking into consideration the survey’s complex design. Results: Our final study sample consisted of 15,651 surveyed individuals (mean age: 58.5 ± 12 years, 46% male). Overall, 46% engaged in at least moderate exercise, translating to 21 million physically active adults in the U.S. Of those with CVD, 34% reported PA, vs. 47% without CVD. In those without CVD, a higher prevalence of PA was noted with lower MRF burden (≥ 3: 35%, 2: 44%, 0-1: 53%). Generally, participants reporting moderate-vigorous PA incurred significantly lower healthcare costs, seen both in those with and without CVD. Among those without CVD, those engaged in moderate-vigorous PA with 0-1 & ≥ 3 MRF had $1,038 & $1,785 less healthcare expenditure, respectively, than their less physically active counterparts. Conclusion: In addition to tremendously improving CVD risk, moderate-vigorous PA is also associated with significantly less healthcare spending. Our findings further reinforce the importance of physical activity in health promotion and CVD prevention.

scholarly journals International Environmental Efficiency Trends and the Impact of the Paris Agreement

Energies ◽  
2021 ◽  
Vol 14 (15) ◽  
pp. 4503
Author(s):  
Wen-Chi Yang ◽  
Wen-Min Lu ◽  
Alagu Perumal Ramasamy
Keyword(s):  
Low Income ◽  
Dynamic Change ◽  
Income Group ◽  
Paris Agreement ◽  
High Income ◽  
Environmental Efficiency ◽  
High Income Group ◽  
Middle Income ◽  
Income Groups ◽  
The Impact

This study estimates the environmental efficiency of 150 economies during the period of 2010–2017 to understand the environmental efficiency trend worldwide. This research adopts the meta-Malmquist approach to compare and capture the dynamic change in environmental efficiency among different income groups. The empirical results indicate that among the four income groups, only the low-income group suffers from regression in terms of environmental efficiency, while the high-income group achieves the greatest progress. For the high-income group, the source of improvement originates from the frontier shift rather than from efficiency change. By contrast, the improvement of the lower-income groups results from the catching-up effect. With regard to the effect of the Paris Agreement, only the lower middle-income group exhibits a statistical difference between the two periods, and environmental efficiency increases after the adoption of the Paris Agreement. The fight against global warming cannot succeed by relying only on specific countries. The whole world must cooperate and improve together, and thus, additional help must be devoted to the low-income group. The statistical results support that differences exist in terms of environmental efficiency among the four income groups. In particular, the low-income group is deteriorating.

scholarly journals Income Heterogeneity and the Environmental Kuznets Curve Turning Points: Evidence from Africa

2021 ◽  
Vol 13 (10) ◽  
pp. 5634
Author(s):  
Mark Awe Tachega ◽  
Xilong Yao ◽  
Yang Liu ◽  
Dulal Ahmed ◽  
Wilhermina Ackaah ◽  
...  
Keyword(s):  
Economic Growth ◽  
Renewable Energy ◽  
Low Income ◽  
Environmental Kuznets Curve ◽  
Turning Points ◽  
High Income ◽  
Least Square ◽  
Kuznets Curve ◽  
Middle Income ◽  
Income Groups

The concept of environmental sustainability aims to achieve economic development while achieving a sustainable environment. The inverted U-shape relationship between economic growth and environmental quality, also called Environmental Kuznets Curve (EKC), describes the correlation between economic growth and carbon emissions. This study assesses the role of agriculture and energy-related variables while evaluating the EKC threshold in 54 African economies, and income groups, according to World Bank categorization, including low income, lower-middle, upper-middle, and high-income in Africa. With 1990–2015 panel data, the results are estimated using panel cointegration, Fully Modified Ordinary Least Square (FMOLS), and granger causality tests. The results are: (1) The study validated the EKC hypothesis in the low-income, lower-, and upper-middle-income economies. However, there is no evidence of EKC in the full African and high-income panels. Furthermore, the turning points of EKC in the income group are meagerly low, showing that Africa could be turning on EKC at lower income levels. (2) The correlation between agriculture with CO2 is found positive in the high-income economy. However, agriculture has a mitigation effect on emissions in the lower-middle-income and low-income economies, and the full sample. Also, renewable energy is negatively correlated with emissions in Africa and the high-income economy. In contrast, non-renewable energy exerts a positive effect on emissions in all income groups except the low-income economies.

scholarly journals Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

2020 ◽  
Vol 5 (11) ◽  
pp. e002640
Author(s):  
Clara Kayei Chow ◽  
Tu Ngoc Nguyen ◽  
Simone Marschner ◽  
Rafael Diaz ◽  
Omar Rahman ◽  
...  
Keyword(s):  
Low Income ◽  
High Income ◽  
Low Income Countries ◽  
Major Adverse Cardiovascular Events ◽  
Cvd Risk ◽  
Middle Income ◽  
Urban Rural ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ObjectivesWe aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.MethodsWe defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.ResultsOf 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).ConclusionLower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.

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