Abstract P42: Health Professional Shortage Areas, Insurance Status, and Cardiovascular Disease Prevention in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Background: Uninsured individuals and those living in federally designated Health Professional Shortage Areas (HPSA) face considerable access barriers and, consequently, may receive less cardiovascular disease (CVD) preventive care. Methods: REGARDS is a national cohort of 30,239 African American (AA) and White community dwelling individuals >45 years of age recruited between 2003 and 2007. We investigated 5 CVD prevention guidelines: 1) aspirin in those with coronary heart disease (CHD), 2) beta-blockers (BB) following myocardial infarction, 3) angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers in those with diabetes or CVD and either hypertension or chronic kidney disease, 4) statins in those with diabetes or CHD, and 5) warfarin for atrial fibrillation. We compared use of these medications by insurance status and HPSA county residence, adjusting for sociodemographics, health behaviors, and health status. Counties with partial HPSA status were excluded. Results: Mean age of participants was 64±9 years, 42% were AA, 55% were women, 93% were insured; 2,548 participants resided in complete HPSA counties and 17,441 in non-HPSA counties, representing 340 of 842 complete HPSA and 1,145 of 1,792 non-HPSA counties nationally. The odds of receiving aspirin, BBs, and ACEI by were similar by HPSA county type and insurance status. However, the odds of receiving statin therapy were lower among uninsured participants, regardless of county type (Table). Conclusions: Residence in HPSA counties was not associated with less CVD prevention. However, a combination of lack of insurance and residence in a HPSA county defined those with the lowest recommended statin use, suggesting lack of access to newer, more expensive therapies among those with both financial and geographic barriers to primary care. | | Aspirin | Beta-Blockers | ACEI or ARB | Statin | Warfarin | |:---------------------------------------- | ---------------- | ---------------- | ---------------- | ---------------- | ---------------- | | Insured residents of HPSA counties | 1.19 (0.79-1.80) | 1.05 (0.75-1.47) | 1.08 (0.90-1.30) | 1.01 (0.84-1.21) | 1.42 (0.93-2.17) | | Uninsured residents of non-HPSA counties | 1.33 (0.66-2.64) | 1.47 (0.78-2.74) | 0.98 (0.75-1.28) | 0.74 (0.57-0.96) | 1.44 (0.65-3.21) | | Uninsured residents of HPSA counties | 0.92 (0.26-3.24) | 1.01 (0.31-3.25) | 0.98 (0.58-1.65) | 0.54 (0.33-0.90) | [**][1] | * [↵][2]* Adjusted for age, race, gender, education, income, percent of county population below poverty, medication adherence, functional capacity, and depressive symptoms. ACEI=angiotensin converting enzyme inhibitor, ARB=angiotensin receptor blocker, CVD=Cardiovascular Disease, HPSA=Health Professional Shortage Area. * [↵][3]** Adjusted OR not available due to few available individuals; unadjusted OR=0.14 (0.02-1.08). Adjusted OR* (95% CI) for Recommended Medications Compared to Insured Residents of non-HPSA Counties [1]: #fn-2 [2]: #xref-fn-1-1 [3]: #xref-fn-2-1