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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Awareness and management of chronic disease, insurance status, and health professional shortage areas in the REasons for Geographic And Racial Differences in Stroke (REGARDS): a cross-sectional study

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Raegan W Durant, Gaurav Parmar, Faisal Shuaib, Anh Le, Todd M Brown, David L Roth, Martha Hovater, Jewell H Halanych, James M Shikany, Ronald J Prineas, Tandaw J Samdarshi, Monika M Safford
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-208) contains supplementary material, which is available to authorized users.

Competing interests

The author(s) declare that they have no competing interests.

Authors’ contributions

RD conceived of the study design, interpreted the data analysis, and drafted and revised the manuscript. GP participated in the conception of the manuscript, conducted portions of the data analysis related to assigning HPSA status to REGARDS participants, and assisted in reviewing and revising the manuscript. FS participated in event ascertainment, conducted portions of the data analysis related to assigning HPSA status to REGARDS participants, and assisted in reviewing and revising the manuscript. AL assisted in conducting and interpreting the data analysis and the review and revisions of the manuscript. TB assisted in the conception of the study, interpretation of the data analysis, and review and revisions of the manuscript. DR assisted in the planning and interpretation of the data analysis and the review and revisions of the manuscript. MH assisted in the planning of the data analysis, conducted portions of the data analysis related to predictive probabilities, and reviewed and revised the manuscript. JH assisted in the conception of the study, interpretation of the data analysis, and review and revisions of the manuscript. JS assisted in the conception of the study, interpretation of the data analysis, and review and revisions of the manuscript. RP assisted in the conception of the study, interpretation of the data analysis, and review and revisions of the manuscript. MS assisted in the conception and design of the study, planning and interpretation of the data analysis, and review and revisions of the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Limited financial and geographic access to primary care can adversely influence chronic disease outcomes. We examined variation in awareness, treatment, and control of hypertension, diabetes, and hyperlipidemia according to both geographic and financial access to care.

Methods

We analyzed data on 17,458 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study with either hypertension, hyperlipidemia, or diabetes and living in either complete Health Professional Shortage Area (HPSA) counties or non-HPSA counties in the U.S. All analyses were stratified by insurance status and adjusted for sociodemographics and health behaviors.

Results

2,261 residents lived in HPSA counties and 15,197 in non-HPSA counties. Among the uninsured, HPSA residents had higher awareness of both hypertension (adjusted OR 2.30, 95% CI 1.08, 4.89) and hyperlipidemia (adjusted OR 1.50, 95% CI 1.01, 2.22) compared to non-HPSA residents. Also among the uninsured, HPSA residents with hypertension had lower blood pressure control (adjusted OR 0.45, 95% CI 0.29, 0.71) compared with non-HPSA residents. Similar differences in awareness and control according to HPSA residence were absent among the insured.

Conclusions

Despite similar or higher awareness of some chronic diseases, uninsured HPSA residents may achieve control of hypertension at lower rates compared to uninsured non-HPSA residents. Federal allocations in HPSAs should target improved quality of care as well as increasing the number of available physicians.
Zusatzmaterial
Authors’ original file for figure 1
12913_2011_2449_MOESM1_ESM.pdf
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