Abstract 252: Regional Variations in Access to Care Among U.S. Veterans With Cardiovascular Disease

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Background: It is unclear whether access to health care for veterans with cardiovascular disease (CVD) vary among U.S. regions. This study sought to determine the extent of regional variations in access to medical care in a cohort of U.S. veterans with CVD.Methods: The 2016 Centers for Disease Control Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of veterans with cardiovascular disease. Participants were classified based on four U.S. regions: (1) Northeast, (2) Midwest, (3) South, and (4) West. Presence of CVD was noted with a single affirmative response to the following questions: “Has a health care professional ever told you that you had any of the following:” (1) a heart attack or myocardial infarction, (2) angina or coronary heart disease, (3) a stroke? Demographic data, baseline medical history, and access to care for veterans of each U.S. region were compared.Results: Among the 13,835 veterans with CVD, 18.3% were from the Northeast, while 23.5%, 37.1%, and 21.0% were from the Midwest, South, and West respectively. Veterans from South were more likely to be younger (21.4% vs 18.5% in the Northeast vs 18.6% in the Midwest vs 19.1% in the West, p=0.0018) and Black (9.7% vs 2% in the Northeast vs 3.3% in the Midwest vs 1.9% in the West, p<.0001). Veterans from West had the highest proportion of females (4.9% vs 3.8% in the Northeast vs 3.5% in the Midwest vs 4.8% in the South) and Hispanics (4.3% vs 2.3% in the Northeast vs 1.2% in the Midwest vs 1.7 in the South, p<.0001). Veterans from West were more likely to be college educated and have higher annual income compared to their counterparts. Veterans from South had highest rates of depressive disorder (20.5% vs 18.1% in the Northeast vs 18.4% in the Midwest vs 19.3% in the West, p=0.0318) were more likely to be smokers (16.4% vs 14.8% in the Northeast vs 15.4% in the Midwest vs 13.2% in the West, p<.0001), obese (34.4% vs 32.8% in the Northeast vs 34.3% in the Midwest vs 29.7% in the West, p<.0001) and had lowest rates of physical activity (62.3% vs 66.7% in the Northeast vs 66.3% in the Midwest vs 69.6% in the West, p<.0001 ). Rates of medical checkup within the past year (91.7% vs 89.5% vs 91.4% vs 86.6%, p<0.0001) differed significantly among the Northeast, Midwest, South, and West respectively. On multivariate analysis, West region (OR 0.39, 95% CI 0.22 - 0.70) was independently associated with lower rates of medical checkup within the past year compared to the Northeast.Conclusions: In this observational study involving U.S. veterans with CVD, West region was independently associated with lower rates of medical checkup within the past year. Further large-scale studies examining the prevalence of impaired access to care in U.S. veterans with CVD are warranted.

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