Care Coordination Institute, Greenville, SC
Department of Medicine, University of South Carolina School of Medicine, Greenville, SC.
J Am Heart Assoc. 2017 Nov 2;6(11):e006105. doi: 10.1161/JAHA.117.006105.
Low-density lipoprotein cholesterol (LDL-C) control is higher among insured than uninsured adults, but data on time trends and contributing factors are incomplete and important for improving health equity.
Awareness, treatment, and control of elevated LDL-C were compared among insured versus uninsured and publicly versus privately insured adults, aged 21 to 64 years, in National Health and Nutrition Examination Surveys from 2001 to 2004, 2005 to 2008, and 2009 to 2012 using Adult Treatment Panel-3 criteria. Compared with insured adults, uninsured adults were younger; were more often minority; reported lower incomes, less education, and fewer healthcare encounters; and had lower awareness and treatment of elevated LDL-C (<0.0001). LDL-C control was higher among insured than uninsured adults in 2001 to 2004 (mean±SEM, 21.4±1.6% versus 10.5±2.6%; <0.01), and the gap widened by 2009 to 2012 (35.1±1.9% versus 11.3±2.2%; <0.0001). Despite more minorities (<0.01), greater poverty, and less education (<0.001), publicly insured adults had more healthcare visits/year than privately insured adults (<0.001) and similar awareness, treatment, and control of LDL-C from 2001 to 2012. In multivariable logistic regression, significant positive predictors of cholesterol awareness, treatment, and control included more frequent health care (strongest), increasing age, private healthcare insurance versus uninsured, and hypertension. Public insurance (versus uninsured) was a significant positive predictor of LDL-C control, whereas income <200% versus ≥200% of federal poverty was a significant negative predictor.
LDL-C control improved similarly over time in publicly and privately insured adults but was stagnant among the uninsured. Healthcare insurance largely addresses socioeconomic barriers to effective LDL-C management, yet poverty retains an independent adverse effect.
与未参保成年人相比，参保成年人的低密度脂蛋白胆固醇（LDL-C）控制水平更高，但关于时间趋势和促成因素的数据并不完整，对于改善健康公平性很重要。
利用成人治疗小组-3 标准，比较了 2001 年至 2004 年、2005 年至 2008 年和 2009 年至 2012 年全国健康和营养调查中年龄在 21 至 64 岁之间的参保和未参保成年人、公共保险和私人保险成年人中升高的 LDL-C 的知晓率、治疗和控制情况。与参保成年人相比，未参保成年人更年轻；更多为少数民族；报告收入较低、受教育程度较低、医疗保健次数较少；且升高的 LDL-C 知晓率和治疗率较低（<0.0001）。2001 年至 2004 年，参保成年人的 LDL-C 控制水平高于未参保成年人（平均值±SEM，21.4±1.6%与 10.5±2.6%；<0.01），并且到 2009 年至 2012 年差距进一步扩大（35.1±1.9%与 11.3±2.2%；<0.0001）。尽管少数民族比例较高（<0.01）、贫困程度较高和受教育程度较低（<0.001），但公共保险成年人的医疗保健就诊次数/年多于私人保险成年人（<0.001），并且 2001 年至 2012 年 LDL-C 的知晓率、治疗率和控制率相似。在多变量逻辑回归中，胆固醇知晓率、治疗率和控制率的显著正预测因子包括更频繁的医疗保健（最强）、年龄增长、私人医疗保险而非未参保、以及高血压。与未参保相比，公共保险是 LDL-C 控制的显著正预测因子，而收入<200%与≥200%联邦贫困率是 LDL-C 控制的显著负预测因子。
在公共保险和私人保险成年人中，LDL-C 控制水平随时间推移相似地提高，但在未参保成年人中停滞不前。医疗保健保险在很大程度上解决了有效 LDL-C 管理方面的社会经济障碍，但贫困仍然存在独立的不利影响。
