219847 Association between health care access and weight change: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Monday, November 8, 2010 : 1:15 PM - 1:30 PM

Joyce W. Tang, MD , Institute for Healthcare Studies, Northwestern University, Chicago, IL
Norrina B. Allen, PhD , Department of Preventive Medicine, Northwestern University, Chicago, IL
Peter De Chavez, MS , Department of Preventive Medicine, Northwestern University, Chicago, IL
David Goff, MD, PhD , Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC
Catarina Kiefe, PhD, MD , Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
Cora E. Lewis, MD, MSPH , Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
Mercedes Carnethon, PhD , Department of Preventive Medicine, Northwestern University, Chicago, IL
     
Background: Cross sectional studies show that physicians provide sub-optimal rates of weight-related counseling; however, the cumulative impact of health care access on longitudinal weight change has not been studied. Objective: To test the association between health care access and weight change in African-American and Caucasian men and women from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Methods: The CARDIA Study is a multicenter, longitudinal study of the evolution of cardiovascular disease risk factors in young adults. The main outcome variables in this analysis were short (3-year) and long-term (13-year) weight change. The main independent variable was health care access assessed in 1992-3, which was dichotomized as no barriers to access versus one or more barriers to access (health insurance gap, no usual source of care, and not seeking care due to expense). We evaluated differences in mean weight change in those with and without access to healthcare, using multivariable linear regression adjusting for height, age, gender, race, and educational status. Results: 3488 participants had relevant weight data for analysis (47% African-American; 46% male; mean age 32 at year 7 (SD 3.6)). 69% (2413) of participants reported no barriers to access. Those reporting no barriers to access were more likely to be female, full-time employed, older, and more highly educated. Mean weight change was 5.0 pounds (SD 13.1) at 3 years and 18.2 pounds (SD 23.6) at 13 years. There were no differences in mean weight change when comparing those with and without access at both 3 and 13 years (p>0.05 for both) and those patterns were consistent when we stratified by initial weight status (BMI < 25 vs >25 kg/m2). Substitution of change in body mass index or percent body weight for weight change yielded no material differences from the weight change analysis. Conclusion: In the CARDIA study, health care access was not associated with short or long-term weight change. These findings may reflect a missed opportunity in health care encounters to counsel about weight maintenance and weight loss.

Learning Areas:
Chronic disease management and prevention
Public health or related research

Learning Objectives:
Discuss the relationship between health care access and short and long-term weight change.

Keywords: Obesity, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a general internist and health services research fellow focused on studying overweight, obesity, and weight gain.
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.

Back to: 3228.0: Health Services Research: Access to Care