199846 Inequities among the Insured in Awareness, Treatment and Control of Hypertension, Hypercholesterolemia, and Diabetes: Findings from the 2004 NYC HANES

Monday, November 9, 2009: 11:05 AM

Quynh C. Nguyen, MSPH , Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC
Elizabeth Needham Waddell, PhD , Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, New York, NY
Bonnie D. Kerker, PhD, MPH , Division of Epidemiology, NYC Department of Health and Mental Hygiene, New York, NY
Sara L. Huston, PhD , Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC
James C. Thomas, MPH, PhD , Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC
Andrea C. Weathers, MD, DrPH , Department of Maternal and Child Health, University of North Carolina School of Public Health, Chapel Hill, NC
R. Charon Gwynn, PhD , Mailman School of Public Health, Columbia University, New York, NY
     
Objectives: Inequities in chronic disease management are understudied among the insured. Within a diverse population, we compared prevalence, awareness, treatment and control (ATC) of hypertension, hypercholesterolemia and diabetes by sociodemographic and healthcare access factors.

Setting: 2004 New York City HANES, a population-based cross-sectional survey of non-institutionalized NYC adults aged ≥ 20 years (n=1,999).

Results: Compared to the uninsured, the insured had significantly better ATC on all three conditions except for diabetes control adjusting for age, sex, race, income, education, and nativity/length of residency. Nonetheless, inequities by healthcare access and sociodemographics persisted among the insured. Insured adults with a routine place of care were 11 times more likely to be aware of their hypercholesterolemia, more likely to be treated for all three conditions and more likely to be controlled for hypertension and hypercholesterolemia than insured adults with no routine place of care, adjusting for sociodemographic characteristics and insurance type. Among the insured, awareness, treatment and control of hypercholesterolemia were poorer among adults aged 20-39 than older age groups. Men had higher odds of treatment (OR=2.2; 95% CI=1.1-4.4) and control (OR=2.0; 95% CI=1.1–3.4) of hypercholesterolemia and higher odds of glycemic control (OR=4.2; 95% CI=1.5–11.9) than women. Compared to non-Hispanic whites, Hispanics had lower odds of cholesterol control (OR=0.3; 95% CI=0.1–0.9), and Asians had worse glycemic control (OR=0.1; 95%CI=0.0-0.4)

Conclusions: Our study confirms that having a routine place of care predicts better care for chronic conditions and demonstrates the persistence of inequities in their medical management even among the insured.

Learning Objectives:
1. Assess the association between healthcare access (insurance status, insurance type and routine place of care) and the medical management of chronic conditions among the insured in New York City. 2. Assess the persistence of sociodemographic inequities in the medical management of chronic conditions among insured New Yorkers.

Keywords: Disease Management, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a MSPH in epidemiology from the University of North Carolina at Chapel Hill and am pursuing a PhD in epidemiology with a special focus on social epidemiology. I have extensive experience with health surveys that have complex survey designs including the National Longitudinal Study of Adolescent Health (Add Health), the Joint Canada-United States Survey of Health (JCUSH), the Program for International Student Assessment (PISA) and Health Behavioral in School Aged Children (HBSC), and of course the New York City Health and Nutrition Examination Survey (NYC HANES) which is the data upon which this abstract is based. I am continuing to explore inequities in chronic disease with a research study that investigates the extent of disparities in chronic disease among young adults and the biological and behavioral pathways that underlie these disparities. Please see below for a description of current projects. The content of the abstract under submission comes from my master’s thesis which began the summer 2007 when I participated in the Epi Scholars Program at the New York Department of Health and Mental Hygiene. CURRENT PROJECTS 1. “Emerging Disparities in Chronic Disease Risk among Young Adults” (Add Health) Aim: Utilize the National Longitudinal Study of Adolescent Health to examine how observed race/ethnic disparities in chronic disease risk during young adulthood are accounted by social, demographic, and economic characteristics operating at multiple contextual levels and over time. 2. “A Cross-National Comparative Perspective on Racial Disparities in Health: The United States versus Canada” Aim: Utilize the 2002-2003 Joint Canada-United States Survey of Health (JCUSH) to compare racial disparities in chronic conditions, indicators of health status and behavioral risk factors between the United States and Canada 3. “National Variations in Socioeconomic Gradients of Health and, Health Behaviors, and Education” Aim: We are using data from 2000 Program for International Student Assessment (PISA) and 2001 Health Behavioral in School Aged Children (HBSC) to investigate the extent to which socioeconomic inequalities in children’s health and health behaviors are similar to/different from socioeconomic inequalities in children’s educational outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Chronic Disease Epidemiology
See more of: Epidemiology