Association of Social Risk Domains With Poor Cardiovascular Risk Factor Control in US Adults With Diabetes, From 2006 to 2016

Abstract

IMPORTANCEFew studies have examined the association between social risk factors and poor control of cardiovascular disease (CVD) risk factors. OBJECTIVE To examine the sequential association between social risk domains and CVD risk control over time in older adults with diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed core interviews from 4877 US adults with diabetes who were participating in the Health and Retirement Study, a national longitudinal survey of US adults. Participants were older than 50 years, completed the social risk domain questions, and had data on CVD risk factor measures from January 2006 to December 2016. Data were analyzed from June to July 2022.EXPOSURES Five social risk domains were created: (1) economic stability, (2) neighborhood or built environment, (3) education access, (4) health care access, and (5) social or community context. MAIN OUTCOMES AND MEASURESThe 4 primary outcomes were (1) poor glycemic control (hemoglobin A 1c [HbA 1c ] level Ն8.0%), (2) poor blood pressure (BP) control (systolic BPՆ140 mm Hg and diastolic BP Ն90 mm Hg), (3) poor cholesterol control (total cholesterol/high-density lipoprotein ratio Ն5), and (4) a composite of poor CVD risk control (Ն2 poorly controlled glucose level, BP, or cholesterol level). RESULTS Among this cohort of 4877 older adults with diabetes (mean [SD] age, 68.6 [9.8] years;2715 women [55.7%]), 890 participants (18.3%) had an HbA 1c level of 8% or higher, 774 (15.9%) had systolic BP of 140 mm Hg or higher and diastolic BP of 90 mm Hg or higher, 962 (19.7%) had total cholesterol/high-density lipoprotein ratio of 5 or higher, and 437 (9.0%) had at least 2 poorly controlled CVD risk factors. Neighborhood or built environment (ie, adverse social support) was independently associated with poor glycemic control (odds ratio [OR], 1.31; 95% CI, 1.06-1.63), whereas economic stability (ie, medication cost-related nonadherence) (OR, 1.40; 95% CI, 1.04-1.87) and health care access (ie, lack of health insurance) (OR, 1.58; 95% CI, 1.20-2.09) were independently associated with poor BP control after full adjustment. Education access (ie, lack of education) (OR, 1.24; 95% CI, 1.01-1.52) and health care access (ie, lack of health insurance) (OR, 1.31; 95% CI, 1.02-1.68) were independently associated with poor cholesterol control. Health care access (ie, lack of health insurance) was the only social risk domain that was independently associated with having at least 2 poorly controlled CVD risk factors (OR, 1.72; 95% CI, 1.26-2.37). CONCLUSIONS AND RELEVANCEResults of this study suggest that certain social risk domains are associated with control of CVD risk factors over time. Interventions targeting domains, such as (continued) Key Points Question What is the longitudinal association between social risk domains and poor control of cardiovascular disease risk factors in older adults with diabetes? Findings In this cohort study of 4877 older adults with diabetes, the social risk domain of neighborhood or built environment (ie, adverse soci...

The “Medicare effect” on head and neck cancer diagnosis and survival

“…This finding is consistent with prior studies which have found patients with cancers across various anatomic sites, including the head and neck, present with more advanced disease when uninsured 1,21,22 . This trend of patients expanded health care access leading to improved outcomes generalizes near‐universally to both cancer and noncancer diagnoses and outcomes, further supporting the notion that this sort of “Medicare effect” may underlie a number of other disparities in health care 23–30 …”

“…1,21,22 This trend of patients expanded health care access leading to improved outcomes generalizes near-universally to both cancer and noncancer diagnoses and outcomes, further supporting the notion that this sort of "Medicare effect" may underlie a number of other disparities in health care. [23][24][25][26][27][28][29][30] This study represents, to our knowledge, the first to elucidate differences in cancer outcomes by comparing uninsured patients younger than 65 years of age with insured patients older than 65 years of age. Our analysis demonstrated a decreased 5-year CSM which may be mediated by the higher likelihood of receiving cancerspecific surgery for insured patients with head and neck cancer.…”

Association Between Historical Neighborhood Redlining and Cardiovascular Outcomes Among US Veterans With Atherosclerotic Cardiovascular Diseases

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