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