Enyeji Abraham M, Barengo Noel C, Ramirez Gilbert, Ibrahimou Boubakari, Arrieta Alejandro
Department of Global Health, Robert Stempel College of Public Health & Social Works, Florida International University, Miami, USA.
Faculty of Medicine, Riga Stradiņš University, Riga, LVA.
Cureus. 2023 Aug 25;15(8):e44121. doi: 10.7759/cureus.44121. eCollection 2023 Aug.
Background Prior evidence of region-level differences in health outcomes and specialized healthcare services in the US poses questions of whether there are differences in utilization of healthcare that may account for regional differences in healthcare outcomes. This study aimed to examine regional differences in healthcare utilization for individuals with poor cardiovascular health (CVH) compared to those with ideal/intermediate CVH. Methods In this cross-sectional analytical study, two 3-year periods (2008-2010 and 2018-2020) were pooled and analyzed using multivariate Poisson's regression of region on counts of healthcare utilization, while controlling for relevant covariates. The interaction of the non-southern regions with recent years was to reveal how the regional dispersion in healthcare usage was changing over time for the non-southern regions compared to the south. Results The results showed significant regional variation in healthcare usage for individuals with poor CVH, with lower health utilization rates observed primarily in southern states, consistent with higher rates of coronary heart disease in those regions. The impact of a unit improvement on CVH score was to reduce the level of healthcare utilization by 15.7% ([95% CI, 15 - 17%; p < 0.001]) for individuals with poor CVH and 19.1% ([95% CI, 19 - 20%; p < 0.001]) for the intermediate and ideal subgroups, with the Northeast exhibiting the highest level of healthcare usage. Conclusion Our results suggest that there is a need for public health interventions to reduce regional disparities in access to healthcare for the people at greatest risk of cardiovascular events by considering individual factors as well as the broader regional and policy contexts where these people live.
背景 先前关于美国健康结果和专科医疗服务存在地区差异的证据，引发了关于医疗保健利用方面是否存在差异从而可能导致医疗保健结果地区差异的问题。本研究旨在探讨心血管健康状况较差（CVH）的个体与心血管健康状况理想/中等的个体在医疗保健利用方面的地区差异。 方法 在这项横断面分析研究中，我们汇总并分析了两个3年时间段（2008 - 2010年和2018 - 2020年），使用多变量泊松回归分析地区对医疗保健利用次数的影响，同时控制相关协变量。非南部地区与近年的交互作用旨在揭示与南部地区相比，非南部地区医疗保健使用的地区差异随时间如何变化。 结果 结果显示，心血管健康状况较差的个体在医疗保健使用方面存在显著的地区差异，主要在南部各州观察到较低的医疗利用率，这与这些地区较高的冠心病发病率一致。心血管健康状况评分提高一个单位，对心血管健康状况较差的个体医疗保健利用水平降低15.7%（[95%置信区间，15 - 17%；p < 0.001]），对中等和理想亚组降低19.1%（[95%置信区间，19 - 20%；p < 0.001]），东北部的医疗保健使用水平最高。 结论 我们的结果表明，需要采取公共卫生干预措施，通过考虑个体因素以及这些人群居住的更广泛的地区和政策背景，来减少心血管事件风险最高人群在获得医疗保健方面的地区差异。
