Fang Jing, Zhao Guixiang, Wang Guijing, Ayala Carma, Loustalot Fleetwood
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
J Am Heart Assoc. 2016 Dec 21;5(12):e004313. doi: 10.1161/JAHA.116.004313.
Hypertension is a major risk factor for heart disease and stroke. Health insurance coverage affects hypertension treatment and control, but limited information is available for US adults with hypertension who are classified as underinsured.
Using Behavioral Risk Factor Surveillance System 2013 data, we identified adults with self-reported hypertension. On the basis of self-reported health insurance status and health care-related financial burdens, participants were categorized as uninsured, underinsured, or adequately insured. Proxies for health care received included whether they reported taking antihypertensive medications and whether they visited a doctor for a routine checkup in the past year. We assessed the association between health insurance status and health care received, adjusting for selected sociodemographic characteristics. Among 123 257 participants from 38 states and District of Columbia with self-reported hypertension, 12% were uninsured, 26% were underinsured, and 62% were adequately insured. In adjusted models using adequately insured participants as referent, both uninsured (adjusted odds ratio, 0.39; 95% CI, 0.35-0.43) and underinsured (0.83, 0.76-0.89) participants were less likely to report using antihypertensive medication than those of adequately insured participants. Similarly, adjusted odds ratio of visiting a doctor for routine checkup in the past year were 0.25 (0.23-0.28) for those who were uninsured and 0.78 (0.72-0.84) for those who were underinsured compared to those with adequate insurance.
Uninsured and underinsured participants with hypertension were less likely to report receiving care compared to those with adequate insurance coverage. Disparities in health care coverage may necessitate targeted interventions, even among people with health insurance.
高血压是心脏病和中风的主要危险因素。医疗保险覆盖范围会影响高血压的治疗和控制，但关于美国被归类为保险不足的高血压成年人的信息有限。
利用2013年行为危险因素监测系统的数据，我们确定了自我报告患有高血压的成年人。根据自我报告的健康保险状况和与医疗保健相关的经济负担，参与者被分为未参保、保险不足或参保充足。所接受医疗保健的替代指标包括他们是否报告服用降压药以及过去一年是否去看医生进行常规体检。我们评估了健康保险状况与所接受医疗保健之间的关联，并对选定的社会人口学特征进行了调整。在来自38个州和哥伦比亚特区的123257名自我报告患有高血压的参与者中，12%未参保，26%保险不足，62%参保充足。在以参保充足的参与者为参照的调整模型中，未参保（调整后的优势比，0.39；95%可信区间，0.35 - 0.43）和保险不足（0.83，0.76 - 0.89）的参与者报告使用降压药的可能性低于参保充足的参与者。同样，与参保充足的参与者相比，过去一年未参保者去看医生进行常规体检的调整后优势比为0.25（0.23 - 0.28），保险不足者为0.78（0.72 - 0.84）。
与参保充足的高血压患者相比，未参保和保险不足的参与者接受治疗的可能性较小。即使在有医疗保险的人群中，医疗保健覆盖方面的差异可能也需要有针对性的干预措施。
