Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of medicare coverage.

Description

The objectives of this paper were to assess national trends in blood pressure control (in adults with hypertension), glycemic control (in adults with diabetes) and cholesterol level control (in adults with coronary heart disease, stroke or diabetes) as well as trends in sociodemographic differences in control and changes in sociodemographic differences after age 65 associated with Medicare coverage. Using data from the National Health and Nutrition Examination Survey (1999 to 2006), age- and sex-adjusted trends indicated significant improvements in control of blood pressure, HbA1c and cholesterol levels. Estimates of trends remained essentially unchanged after further adjustments for race, ethnicity, education, income, body mass index, smoking status and insurance coverage. Moreover, differences among adults aged 65 to 85 years were smaller than those among adults aged 40 to 64 years for systolic blood pressure (p=0.009 for black-white comparison) and HbA1c (p<0.001 for nonwhite-white comparison, p=0.033 for comparison by education) and tended to be smaller for cholesterol (p=0.087 for comparison by education). Although control of blood pressure and of plasma glucose and cholesterol concentrations has improved in individuals with cardiovascular disease and diabetes, there are still some racial, ethnic and socioeconomic differences in blood pressure and glycemic control that need to be considered and addressed.