Cardiovascular Disease Burden and Outcomes Among American Indian and Alaska Native Medicare Beneficiaries.

Autor:	Eberly LA; Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico.; Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia.; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia.; Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia., Shultz K; Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia., Merino M; Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico., Brueckner MY; Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico., Benally E; Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico., Tennison A; Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico., Biggs S; Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico., Hardie L; Division of General Internal Medicine, Massachusetts General Hospital, Boston., Tian Y; Division of Pulmonary and Critical Care, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania., Nathan AS; Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia.; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia., Khatana SAM; Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia.; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia., Shea JA; Division of General Internal Medicine, University of Pennsylvania, Philadelphia., Lewis E; Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California., Bukhman G; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.; Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts.; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Shin S; Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico.; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts., Groeneveld PW; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.; Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2023 Sep 05; Vol. 6 (9), pp. e2334923. Date of Electronic Publication: 2023 Sep 05.
DOI:	10.1001/jamanetworkopen.2023.34923
Abstrakt:	Importance: American Indian and Alaska Native persons face significant health disparities; however, data regarding the burden of cardiovascular disease in the current era is limited. Objective: To determine the incidence and prevalence of cardiovascular disease, the burden of comorbid conditions, including cardiovascular disease risk factors, and associated mortality among American Indian and Alaska Native patients with Medicare insurance. Design, Setting, and Participants: This was a population-based cohort study conducted from January 2015 to December 2019 using Medicare administrative data. Participants included American Indian and Alaska Native Medicare beneficiaries 65 years and older enrolled in both Medicare part A and B fee-for-service Medicare. Statistical analyses were performed from November 2022 to April 2023. Main Outcomes and Measures: The annual incidence, prevalence, and mortality associated with coronary artery disease (CAD), heart failure (HF), atrial fibrillation/flutter (AF), and cerebrovascular disease (stroke or transient ischemic attack [TIA]). Results: Among 220 598 American Indian and Alaska Native Medicare beneficiaries, the median (IQR) age was 72.5 (68.5-79.0) years, 127 402 were female (57.8%), 78 438 (38.8%) came from communities in the most economically distressed quintile in the Distressed Communities Index. In the cohort, 44.8% of patients (98 833) were diagnosed with diabetes, 61.3% (135 124) were diagnosed with hyperlipidemia, and 72.2% (159 365) were diagnosed with hypertension during the study period. The prevalence of CAD was 38.6% (61 125 patients) in 2015 and 36.7% (68 130 patients) in 2019 (P < .001). The incidence of acute myocardial infarction increased from 6.9 per 1000 person-years in 2015 to 7.7 per 1000 patient-years in 2019 (percentage change, 4.79%; P < .001). The prevalence of HF was 22.9% (36 288 patients) in 2015 and 21.4% (39 857 patients) in 2019 (P < .001). The incidence of HF increased from 26.1 per 1000 person-years in 2015 to 27.0 per 1000 person-years in 2019 (percentage change, 4.08%; P < .001). AF had a stable prevalence of 9% during the study period (2015: 9.4% [14 899 patients] vs 2019: 9.3% [25 175 patients]). The incidence of stroke or TIA decreased slightly throughout the study period (12.7 per 1000 person-years in 2015 and 12.1 per 1000 person-years in 2019; percentage change, 5.08; P = .004). Fifty percent of patients (110 244) had at least 1 severe cardiovascular condition (CAD, HF, AF, or cerebrovascular disease), and the overall mortality rate for the cohort was 19.8% (43 589 patients). Conclusions and Relevance: In this large cohort study of American Indian and Alaska Native patients with Medicare insurance in the US, results suggest a significant burden of cardiovascular disease and cardiometabolic risk factors. These results highlight the critical need for future efforts to prioritize the cardiovascular health of this population.
Databáze:	MEDLINE
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