Dataset Information

Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.

ABSTRACT:

Purpose

Cardiovascular disease (CVD) is the number one cause of death among 5-year cancer survivors. Survivors see many providers and poor coordination may contribute to worse CVD risk factor control. We sought to determine associations between fragmentation and CVD risk factor control among survivors overall and by self-rated health.

Methods

We included REGARDS participants aged 66+ years who (1) had a cancer history; (2) reported diabetes, hypertension, or hyperlipidemia; and (3) had continuous Medicare coverage. Twelve-month ambulatory care fragmentation was calculated using the Bice-Boxerman Index (BBI). We determined associations between fragmentation and CVD risk factors, defining "control" as fasting glucose < 126 mg/dL or non-fasting glucose < 200 mg/dL for diabetes; blood pressure < 140/90 mmHg for hypertension; and total cholesterol <240 mg/dL, low-density lipoprotein cholesterol < 160 mg/dL, or high-density lipoprotein cholesterol >40 mg/dL for hyperlipidemia.

Results

The 1002 cancer survivors (2+ years since cancer treatment) had mean age of 75 years, 39% were women, and 23% were Black. Among individuals with diabetes (N = 225), hypertension (N = 660), and hyperlipidemia (N = 516), separately, approximately 60% had CVD risk factor control. Overall, more fragmented care was not associated with worse control. However, among cancer survivors with excellent, very good, or good health, more fragmentation was associated with a decreased likelihood of diabetes control (OR 0.78, 95% CI 0.61-0.99), adjusting for confounders.

Conclusions

More fragmented care was associated with worse glycemic control among cancer survivors with diabetes who reported excellent, very good, or good health. Associations were not observed for control of hypertension or hyperlipidemia.

Implications for cancer survivors

Reducing fragmentation may support glucose control among survivors with diabetes.

SUBMITTER: Pinheiro LC

PROVIDER: S-EPMC7937763 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Pinheiro Laura C LC Reshetnyak Evgeniya E Safford Monika M MM Nanus David D Kern Lisa M LM

Journal of cancer survivorship : research and practice 20200908 2

<h4>Purpose</h4>Cardiovascular disease (CVD) is the number one cause of death among 5-year cancer survivors. Survivors see many providers and poor coordination may contribute to worse CVD risk factor control. We sought to determine associations between fragmentation and CVD risk factor control among survivors overall and by self-rated health.<h4>Methods</h4>We included REGARDS participants aged 66+ years who (1) had a cancer history; (2) reported diabetes, hypertension, or hyperlipidemia; and (3 ...[more]

PMID: 32901370

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Project description:Albuminuria is an important risk factor for progressive chronic kidney disease (CKD) and is more prevalent in black than white adults. We sought to determine the association between low income and albuminuria and whether this association differs for blacks and whites.Cross-sectional study.9,144 black and 13,684 white US adults 45 years and older in the population-based Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.Self-reported annual household income category (?$75,000, $35,000-$74,999, $20,000-$34,999, and <$20,000); black and white race.Albuminuria defined as high (30-300 mg/g) or very high (>300 mg/g) urinary albumin-creatinine ratio (ACR). Multinomial logistic regression used to examine the race-stratified association between categories of income and albuminuria (normal, high, or very high ACR).Overall, geometric mean ACR was 10.2 mg/g and was higher for blacks (11.8 mg/g) than whites (9.3 mg/g), P<0.001. Lower income was associated with a higher prevalence of albuminuria for both whites and blacks in unadjusted analyses. After adjustment for demographics, lifestyle factors, comorbid illnesses, and estimated glomerular filtration rate, there was a trend toward a stronger association between lower income levels and high ACR in blacks (ORs of 1.38 [95% CI, 1.07-1.77], 1.36 [95% CI, 1.05-1.75], and 1.58 [95% CI, 1.21-2.05] for income levels of $35,000-$74,999, $20,000-$34,999, and <$20,000, respectively; reference group is those with income?$75,000) compared with whites (ORs of 0.95 [95% CI, 0.81-1.12], 0.95 [95% CI, 0.79-1.14], and 1.26 [95% CI, 1.02-1.55], respectively); P interaction=0.08 between race and income. Results were similar for very high ACR and subgroups of participants with diabetes or hypertension.Cross-sectional design; not all REGARDS participants provided their annual income.Lower income may be associated more strongly with albuminuria in blacks than whites and may be a determinant of racial disparities in albuminuria.

Dataset Information

Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Purpose

Methods

Results

Conclusions

Implications for cancer survivors

Publications

Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Similar Datasets

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