Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older.

BACKGROUND: Adults aged 65 and older are disproportionately affected by hypertension, dyslipidemia, and diabetes, which are established risk factors for cardiovascular disease (CVD). Although risk reduction strategies among older adults, including control of CVD risk factors, can lead to a decline in premature CVD morbidity and mortality, the prevalence of these risk factors has generally increased in the past decade among elders and risk factor control rates have been suboptimal. We assess prevalence, awareness, treatment, and control rates among U.S. adults aged 65 and older with respect to hypertension, dyslipidemia, and diabetes and describe predictors associated with awareness and management of these factors. METHODS: Analysis of nationally representative data collected from adults aged 65 and older (n = 3,810) participating in the National Health and Nutrition Examination Survey 1999-2004. RESULTS: Women have a significantly higher prevalence of hypertension than men (76.6% vs 63.0%) and a significantly lower rate of control when treated pharmacologically (42.9% vs 57.9%). Dyslipidemia prevalence is 60.3% overall, and women are significantly more likely to be aware of their condition than men (71.1% vs 59.1%). Diabetes affects 21.2% of older adults, and 50.9% of prevalent cases are treated pharmacologically. Goal attainment among those treated is problematic for all three conditions-hypertension (48.8%), dyslipidemia (64.9%), and diabetes (50.4%). Having two or more doctor visits annually is associated with goal attainment for dyslipidemia. CONCLUSIONS: Knowledge of cardiovascular health in older adults and understanding gender gaps in awareness can help physicians and policymakers improve disease management and patient education programs.

Racial and ethnic disparities in the prevalence and management of cardiovascular risk factors in the United States workforce.

OBJECTIVE: To assess racial or ethnic differences in workers with respect to awareness, treatment, and control of hypertension, diabetes, and dyslipidemia, and to identify factors associated with these disparities. METHODS: Analysis of nationally representative data collected from employed persons participating in the National Health and Nutrition Examination Survey 1999 to 2002, with sub-analyses by race and ethnicity. RESULTS: Mexican-American workers are less likely than non-Hispanic whites to be aware of their hypertension (odds ratio [OR] = 0.60; 95% confidence interval [CI] = 0.39-0.94) and less likely to be treated (OR = 0.45; 95% CI = 0.23-0.85); less likely to be aware (OR = 0.56; 95% CI = 0.33-0.93) and treated (OR = 0.33; 95% CI = 0.14-0.78) for dyslipidemia; and more likely to be aware of diabetes (OR = 3.01; 95% CI = 1.14-7.95). Non-Hispanic blacks treated for hypertension are less likely than whites to reach blood pressure goal (OR = 0.47; 95% CI = 0.33-0.66). Having a usual place of care is independently associated with awareness and treatment for hypertension, and treatment for dyslipidemia. CONCLUSION: Understanding cardiovascular health disparities in the workforce can help employers structure appropriate workplace screening and prevention programs.

Diabetes, hypertension, and dyslipidemia in Mexican Americans and non-Hispanic whites.

BACKGROUND: Ethnic disparities in healthcare quality have been documented, but knowledge of differences in cardiovascular risk factor prevalence, awareness, treatment, and control between Mexican Americans and non-Hispanic whites remains incomplete. METHODS: Cross-sectional analysis in 2005 of nationally representative data collected from 2256 Mexican-American and 4624 non-Hispanic white adults aged 20 years and over who participated in the 1999-2002 National Health and Nutrition Examination Survey. RESULTS: Type 2 diabetes is significantly more prevalent in Mexican Americans (13% age and gender adjusted) than in non-Hispanic whites (8%); however, Mexican Americans are more likely to be both diagnosed (77% vs 65%) and treated (63% vs 47%). There is no significant difference in the adjusted prevalence of hypertension, at 28% for non-Hispanic whites compared to 26% for Mexican Americans. Mexican Americans have a slightly lower adjusted prevalence of dyslipidemia, at 31% versus 35%. Awareness of hypertension and dyslipidemia are significantly lower in Mexican Americans (57% vs 71% for hypertension, and 33% vs 56% for dyslipidemia). Treatment rates for hypertension and dyslipidemia are also significantly lower in Mexican Americans (42% vs 61% for hypertension; 14% vs 30% for dyslipidemia). Multivariate logistic regression controlling for age, gender, education, and access to care indicate that Mexican Americans are significantly more likely than non-Hispanic whites to be aware and treated for their diabetes, but significantly less likely to be aware and treated for their hypertension or dyslipidemia. CONCLUSIONS: The significantly higher prevalence of diabetes in Mexican Americans, in contrast to hypertension and dyslipidemia, may sensitize healthcare providers to its detection and treatment. Communicating the importance of hypertension and dyslipidemia is essential for eliminating disparities.

Racial disparities in hypertension prevalence, awareness, and management.

BACKGROUND: Effectively reducing cardiovascular disease disparities requires identifying and reducing disparities in risk factors. Improved understanding of hypertension disparities is critical. METHODS: Cross-sectional analysis of nationally representative samples of black and white adults 20 years and older who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2002 (white, n = 4624; black, n = 1837) and NHANES III conducted in 1988-1994 (white, n = 7121; black, n = 4709). We examined differences in hypertension prevalence, awareness, treatment, and blood pressure (BP) control among both treated and prevalent cases across the 2 periods. RESULTS: Hypertension prevalence increased significantly from 35.8% to 41.4% among blacks and from 24.3% to 28.1% among whites and remains significantly higher among blacks. Awareness is higher among blacks (77.7% vs 70.4%; P<.001), as is treatment (68.2% vs 60.4%; P<.001). These results are driven by higher rates in black women. Blood pressure control rates among those treated have increased in both races, primarily as a result of increased BP control in black and white men (27.3% and 44.7%, respectively; P

Healthcare spending among community-dwelling adults with schizophrenia.

BACKGROUND: Although expenditures for schizophrenia have been documented previously, direct medical expenses have not been updated to reflect the most recent national data available. OBJECTIVE: To identify current direct medical expenditures for schizophrenia and comorbidities among community-dwelling adults in the United States. STUDY DESIGN: Cross-sectional. METHODS: Nationally representative data from the 2001 and 2002 Medical Expenditure Panel Surveys were analyzed to identify community-dwelling adults, aged 20 years, who incurred expenses for selected comorbidities. Annual direct medical spending estimates by site of service and payer source were produced using the average of these 2-year data. Mean and median per-person comorbidity costs among patients with schizophrenia expenses were determined for the following conditions: diabetes, hypertension, heart disease, and dyslipidemia. RESULTS: Five hundred seventy-one thousand community-dwelling adults incurred USD 2.13 billion per year in direct medical expenses for schizophrenia in 2001-2002; mean and median yearly per-patient expenses were USD 3726 and USD 1748, respectively. Inpatient care accounted for 13% of expenditures, while ambulatory care and prescription drugs accounted for 75%. Medicaid incurred USD 1 billion spent on schizophrenia treatment. Mean per-person spending for schizophrenia patients with comorbidities ranged from USD 3913 per year for those with comorbid hypertension to USD 5618 per year for those with comorbid dyslipidemia. Mean annual total healthcare expenditures for patients with schizophrenia ranged from USD 5990 for those with no comorbid conditions to USD 12 292 for those with comorbid hypertension. CONCLUSION: The majority of schizophrenia expenses incurred by patients living in the community occur in an outpatient setting and not in the hospital. Medicaid is the primary payer source for this condition. Among adults with schizophrenia, the costs of comorbidities vary by condition, but are associated with increased expenditures.

Adherence with pharmacotherapy for type 2 diabetes: a retrospective cohort study of adults with employer-sponsored health insurance.

BACKGROUND: Trials have shown that intensive therapy to control blood glucose levels results in lower rates of microvascular complications and myocardial infarction among patients with type 2 diabetes. They have also demonstrated the economic and quality-of-life benefits of improved glycemic control among this patient population. Glycemic control achievable in controlled settings, however, may differ from that observed in actual practice settings, in part due to the patient's autonomy in determining whether, or to what extent, adherence to the prescribed regimen is acceptable. OBJECTIVE: The goal of this study was to determine adherence with pharmacotherapy for type 2 diabetes among newly treated working-aged adults (ie, those aged 18-64 years) who had employer-sponsored health insurance. Adherence was defined as the regular refilling of prescriptions as indicated, such that an appropriate supply of medication is available over time. METHODS: A retrospective cohort study of newly treated patients (aged 18-64 years) was conducted using an administrative claims database with coverage from 1997 through 2000. Eligibility required at least 12 months of history before and after the index prescription date. Early nonpersistence (failure to fill a second prescription for the index drug or any other antihyperglycemic medication) and 12-month non-persistence rates were calculated, as was nonadherence based on a medication possession ratio (MPR) <80%. Survival and logistic regression models were used to examine adherence rates and behavior predictors. RESULTS: A total of 6090 patients (median age, 51.0 years; 3263 men, 2827 women) were included. After the first prescription, 10.5% of patients (95% CI, 9.8-11.3) failed to fill a second prescription for the initial or any other antihyperglycemic medication. At 12 months after the initial prescription date, 37.0% of patients (95% CI, 35.8-38.2) had discontinued pharmacotherapy. During the period of persistence (the time interval during which prescriptions were being filled), 46.2% of patients (95% CI, 44.7-47.7) were nonadherent according to the MPR-based analysis. After adjustment for covariates, younger age (ie, 18-24 years) and female gender were found to be risk factors for early nonpersistence (odds ratio [OR], 1.77 [95% CI, 1.07-2.94] and OR, 1.47 [95% CI, 1.25-1.73], respectively) and for discontinuation over time (hazard ratio [HR], 2.44 [95% CI, 1.89-3.15] and HR, 1.18 [95% CI, 1.09-1.28], respectively). Another risk factor for early nonpersistence and discontinuation over time was initial treatment using insulin (OR, 3.00 [95% CI, 2.30-3.91]; HR, 2.68 [95% CI, 2.31-3.10]) or an alpha-glucosidase inhibitor (OR, 2.07 [95% CI, 1.11-3.84]; HR, 1.57 [95% CI, 1.11-2.22]). CONCLUSIONS: Adherence with antihyperglycemic pharmacotherapy was poor among working-aged patients newly treated for type 2 diabetes. Patients prescribed insulin as initial pharmacotherapy were less likely to persist on medication than those initially prescribed oral agents.

The impact of obesity on work limitations and cardiovascular risk factors in the U.S. workforce.

OBJECTIVE: We document the association among obesity, cardiovascular risk factors, and work limitations in the U.S. workforce. METHODS: Using clinical measurements from the National Health and Nutrition Examination Survey III and 1999-2000, we analyzed obesity rates and cardiovascular risk factor prevalence. We examined work limitations using the National Health Interview Survey 2002. RESULTS: Obesity increased 43.8% from 1988-1994 to 1999-2000 and now affects 29.4% of workers. Obese workers have the highest prevalence of work limitations (6.9% vs. 3.0% among normal-weight workers), hypertension (35.3% vs. 8.8%), dyslipidemia (36.4% vs. 22.1%), type 2 diabetes (11.9% vs. 3.2%), and the metabolic syndrome (53.6% vs. 5.7%). We also found increased prevalence rates among those classified as overweight. CONCLUSIONS: Our study documents the association between excess body weight and health outcomes. Workplace weight and disease management programs could reduce morbidity and increase productivity.