This study aimed to characterize patterns of preventive care service utilization for cardiovascular disease and predict trends in a U.S. population using national health survey data. Descriptive analyses found high utilization of blood pressure and cholesterol screening across populations. Logistic regression identified factors associated with screening, such as women and Asians being less likely than men and other races to receive screenings. The results can help guide policies to reinforce screening guidelines for underserved groups.

1. Predicting Trends in Preventive Care Service Utilization Impacting Cardiovascular Outcomes in a United States Population Gautam Partha, B. Pharm.1,4 Varun Vaidya, B. Pharm., PhD.2,4 Jennifer Howe, B.S.P.S.3,4 Research Associate Assistant Professor Research Assistant The University of Toledo College of Pharmacy, Pharmacy Health Care Administration, Toledo, Ohio;

2. Background 2 Preventive Care refers to any intervention designed to avert disease or injury1 Includes immunizations, disease screenings and behavioral counseling2 These types of interventions are likely to have a significant impact on increasing quality of life while reducing premature mortality3,4 Approximately 40% of all deaths in the U.S, including heart disease and stroke, have been attributed to controllable risk factors, i.e. tobacco use, poor diet, physical inactivity and alcohol misuse1,5,6 Diseases such as hypertension and hyperlipidemia, especially if untreated, put individuals at an increased risk for heart disease and stroke7,8

3. Background 3 Hypertension (HTN) Currently affects 29% of the U.S. population, 28% are considered pre-hypertensive9 22% of hypertensives are unaware of their condition9 23,965 or 7.9 per 100,000 deaths in U.S. in 200710 Hyperlipidemia (HL)11 Currently affects 105 million Americans Nearly 17% of population 4.4 million deaths worldwide If not treated, heart disease could develop, known as the “Silent Killer” because there are no noticeable symptoms12 Regular screening is necessary to diagnose and monitor HTN, HL. The maximum benefit of blood pressure and cholesterol screening is achieved through long-term use of drug therapy2

4. Background 4 Trends over time in cardiovascular preventive care utilization using population-based monitoring Blood Pressure Screening 22.2% in1991 report being told they have high blood pressure by a health care provider, 24.9% in 1999 (BRFSS)8 86.5% among all adults 18 years and older in 20032 Cholesterol Screening 79.4% among men over 35 and women over 45 in 20032 1 in 5 at risk adults have not been screened within the last five years2

5. Need for Study 5 Existing literature mainly focuses on preventive care utilization among population groups already inflicted with disease or disability13-16 Research has not yet characterized specific populations more likely to utilize preventive care services Although there is existing evidence indicating disparities, few studies using predictions have been conducted2 Blood pressure and cholesterol screenings are deemed as priorities among clinical preventive service utilization and have continuously proven to be cost-effective17 A global perspective on cardiovascular preventive care utilization should be conducted and include all eligible individuals Findings from this study will draw the attention of policymakers towards individuals less likely to use prevention services, thus enabling strict reinforcement of certain health care recommendations to all individuals

6. Study Objectives 6 To characterize the utilization pattern of preventive care services impacting cardiovascular outcomes in a U.S population using a national database To predict the trends in cardiovascular preventive care services in a U.S. population

7. Methods 7 Study Design: Retrospective Cross-Sectional Data Source: Medical Expenditures Panel Survey (MEPS) A nationally representative sample of the non-institutionalized, civilian U.S. population in which individuals are interviewed five times over a 2-year period. This study used the most recent available dataset from 2007. Inclusion Criteria: Based on guideline recommendations of JNC-VII and NCEP: Blood Pressure-restricted to individuals over the age of 18 Cholesterol-restricted to individuals over the age of 20

8. Methods 8 Variables collected: Dependent: Utilization of preventive care services ,blood pressure and cholesterol screening (Dichotomous) Independent: Age, gender, race, ethnicity, insurance status, annual income and perceived health status (Categorical) Data Analysis SAS version 9.1 Objective 1:Descriptive Statistics and Chi-Square Analysis Objective 2: Multivariate Logistic Regression

9. Results 9 Demographics (I don’t have this information) ??? Total number of MEPS 2007 data respondents, n= 30,964 20,523 responded for blood pressure screening utilization 15,784 responded for cholesterol screening utilization

10. Results-Blood Pressure Screening 10 Table 1: Utilization Patterns, Chi-Square Analysis

11. Results-Cholesterol Screening 11 Table 2: Utilization Patterns, Chi-Square Analysis

12. Results-Blood Pressure & Cholesterol Screening 12 Table 3: Predicting Trends, Logistic Regression

13. Discussion and Implication 13 Objective 1-Chi-Square Analysis High utilization patterns for both blood pressure and cholesterol screening were recognized among all populations categories

14. Discussion and Implication 14 Objective 2-Logistic Regression Women were less likely than men to obtain cardiovascular screenings, although women are at greater risk for heart disease Western medicine practices often not utilized in individuals of Asian descent which would explain the low utilization of blood pressure screenings compared with other races Older individuals more likely to seek preventive care services since age is a key risk factor for cardiovascular complications Individuals with poor health status utilized more,

15. Discussion and Implication 15 Future research should: further distinguish populations with more characteristics and explore utilizations patterns suggest inferences regarding the causes of varying utilization patterns among populations Awareness of these differences in utilization will help guide policymakers to reinforce the recommended guidelines for blood pressure and cholesterol screenings, especially to those groups in which utilization is lower.

16. References 16 Cohen, Joshua T., Neumann, Peter J., Weinstein, Milton C. Does Preventive Care Save Money? Health Economics and the Presidential Candidates. N Engl. J. Med. 358;7:661-663. Preventive Care: A National Profile on Use, Disparities, and Health Benefits: Partnership for Prevention, 2007. 1-46 p. Marin MG, Zitter JN. Expenditures associated with preventive healthcare. Preventive Medicine. 2004(39):856-62. Nelson DE, Bland S, Powell-Griner E, et al. State Trends in Health Risk Factors and Receipt of Clinical Preventive Services Among U.S. Adults During the 1990s. JAMA. 2002;287(20):2659-67. Leading Causes of Death. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/fastats/lcod.htm Modkad AH, Marks JS, Stroup DF, al. e. Actual Causes of Death in the United States, 2000. JAMA. 2004;291(10):1238-45. Hypertensive Heart Disease. Health Line. http://www.healthline.com/adamcontent/hypertensive-heart-disease. State-Specific Trends in Self-Reported Blood Pressure Screening and High Blood Pressure—United States, 1991-1999.Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5121a2.htm. Hypertension Awareness, Treatment and Control-Continued Disparities in Adults: U.S. 2005-2006. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/data/databriefs/db03.pdf Hypertension. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs.fastasts/hypertens.htm.

17. References, cont. 17 Hyperlipidemia. Pharmasave Statistics. http://content.nhiondemand.com/psv/HC2.asp?objID=100227&cType=hc. Blood Pressure. The American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4473. Wei W, Findley P, Sambamoorthi U. Disability and Receipt of Clinical Preventive Services Among Women. Womens Health Issues. 2006;16(6):286-96. Gold R, DeVoe J, Shah A, Chauvie S. Insurance Continuity and Receipt of Diabetes Preventive Care in a Network of Federally Qualified Health Centers. Medical Care. 2009;47(4):431-9 Witt WP, Kahn R, Fortuna L, et al. Psychological Distress as a Barrier to Preventive Healthcare Among U.S. Women. Journal of Primary Prevention. 2009(30):531-47. Wang, Jean, Carson, Elise, Lapane Kate, Eaton, Charles, Gans Kim, Lasater, Thomas. The Effect of Physician Offics Visits on CHD Risk Factor Modification as Part of a Worksite Cholesterol Screening Program. Preventive Medicine. 1999 (28): 221-228. Maciosek et al. Priorities Among Effective Clinical Preventive Services Results of a Systematic Review and Analysis. Am J Prev Med. 2006; 31(1):52-61.