Skip Navigation
American College of Physicians Logo
  • Subscribe
  • Submit a Manuscript
  • Sign In
    Sign in below to access your subscription for full content
    INDIVIDUAL SIGN IN
    Sign In|Set Up Account
    You will be directed to acponline.org to register and create your Annals account
    INSTITUTIONAL SIGN IN
    Open Athens|Shibboleth|Log In
    Annals of Internal Medicine
    SUBSCRIBE
    Subscribe to Annals of Internal Medicine.
    You will be directed to acponline.org to complete your purchase.
Annals of Internal Medicine Logo Menu
  • Latest
  • Issues
  • Channels
  • CME/MOC
  • In the Clinic
  • Journal Club
  • Web Exclusives
  • Author Info
Advanced Search
  • ‹ PREV ARTICLE
  • This Issue
  • NEXT ARTICLE ›
Summaries for Patients |21 April 2009

Control of Cardiovascular Disease and Diabetes in the United States: Trends in Disparities and Effects of Medicare Coverage Free

  • ‹ PREV ARTICLE
  • This Issue
  • NEXT ARTICLE ›
Jump To
  • Full Article
  • FULL ARTICLE
    • What is the problem and what is known about it so far?
    • Why did the researchers do this particular study?
    • Who was studied?
    • How was the study done?
    • What did the researchers find?
    • What were the limitations of the study?
    • What are the implications of the study?
  • Figures
  • Tables
  • Supplements
  • Audio/Video
  • Summary for Patients
  • Clinical Slide Sets
  • CME / MOC
  • Comments
  • Twitter Link
  • Facebook Link
  • Email Link
More
  • LinkedIn Link
  • CiteULike Link

What is the problem and what is known about it so far?

Research shows that the health care that patients receive and its outcomes differ between racial and ethnic groups. Researchers are now trying to understand why these differences exist and how to reduce or eliminate them. A key question is whether improving the quality of care will narrow the gaps between patients from different racial and ethnic groups.

Why did the researchers do this particular study?

To see if improvement in the quality of care for several common conditions has reduced gaps between racial and ethnic groups in the outcome of that care, and if access to universal health insurance—which occurs at age 65 years, when eligible for the U.S. Medicare system—has reduced gaps in the outcomes of care for different racial and ethnic groups.

Who was studied?

Men and women who participated in the government-sponsored National Health and Nutrition Examination Survey (NHANES) and had hypertension, diabetes, or coronary heart disease. The participants are representative of the U.S. population. They provided information about their medical history; had a physical examination; and received many tests, including tests to measure the status of their condition. After the identity of individuals is concealed, this information becomes available for health care researchers.

How was the study done?

For each person, the authors determined if hypertension, diabetes, or coronary heart disease was well controlled by using standard definitions of adequate disease control. They then compared rates of disease control for 6 years (1999 to 2005) to see if the U.S. health care system was getting better at providing care for these common conditions. They compared disease control for persons age 40 to 64 years with persons age 65 to 85 years to see if disease control was better in those who had Medicare coverage.

What did the researchers find?

Control of hypertension, diabetes, or coronary heart disease greatly improved from 1999 to 2005. However, the differences between white and Hispanic or black patients did not change during this period. The gaps remained the same. On the other hand, the gaps between white patients and Hispanic or black patients who were 65 years or older (and were eligible for Medicare) were smaller than those for younger patients.

What were the limitations of the study?

The NHANES does not provide information about how a person changes over time. To evaluate the effect of age on gaps in disease control, it is necessary to compare groups of patients who differ in age and might differ in other important ways.

What are the implications of the study?

Improving the quality of care without improving access to care does not seem to reduce gaps in the outcomes experienced by different racial and ethnic groups. All racial or ethnic groups get better to the same degree. On the other hand, providing universal access to health insurance seems to narrow gaps in care that minority racial and ethnic groups receive. The findings imply that to narrow gaps in the outcome of health care that minority racial and ethnic groups receive, the United States will have to provide universal access to health care.

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

This feature is available only to Registered Users

Subscribe/Learn More
Submit a Comment

0 Comments

PDF
Not Available
Citations
Citation

Control of Cardiovascular Disease and Diabetes in the United States: Trends in Disparities and Effects of Medicare Coverage. Ann Intern Med. 2009;150:I–26. doi: 10.7326/0003-4819-150-8-200904210-00001

Download citation file:

  • RIS (Zotero)
  • EndNote
  • BibTex
  • Medlars
  • ProCite
  • RefWorks
  • Reference Manager

© 2018

×
Permissions

Published: Ann Intern Med. 2009;150(8):I-26.

DOI: 10.7326/0003-4819-150-8-200904210-00001

0 Citations

See Also

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
View MoreView Less

Related Articles

Looking for Answers in All the Wrong Places
Annals of Internal Medicine; 119 (8): 855-857
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
Annals of Internal Medicine; 150 (8): 505-515
Cost-Effectiveness of Full Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors for Beneficiaries with Diabetes
Annals of Internal Medicine; 143 (2): 89-99
The Cost-Effectiveness of Full Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors for Patients with Diabetes
Annals of Internal Medicine; 143 (2): I-21
View MoreView Less

Journal Club

In stable CVD, rivaroxaban plus aspirin reduced CV events and increased bleeding compared with aspirin alone
Annals of Internal Medicine; 167 (10): JC52
Evolocumab reduced CV events in patients with atherosclerotic CV disease taking high- or moderate-intensity statins
Annals of Internal Medicine; 167 (2): JC7
Guideline: The USPSTF recommends low- to moderate-dose statins to prevent CVD in selected adults 40 to 75 years of age
Annals of Internal Medicine; 166 (6): JC26
In CVD with moderate-to-severe obstructive sleep apnea, adding CPAP to usual care did not reduce major CV events
Annals of Internal Medicine; 165 (10): JC59
View MoreView Less

Related Point of Care

Type 2 Diabetes
Annals of Internal Medicine; 162 (5): ITC1
Type 2 Diabetes
Annals of Internal Medicine; 152 (5): ITC3-1
Peripheral Arterial Disease
Annals of Internal Medicine; 146 (5): ITC3-1
Type 2 Diabetes
Annals of Internal Medicine; 146 (1): ITC1-1
View MoreView Less

Related Topics

Cardiology
Coronary Risk Factors
Diabetes
Endocrine and Metabolism
Healthcare Delivery and Policy

Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Healthcare Delivery and Policy.

CME/MOC Activity Requires Users to be Registered and Logged In.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
The Comments Feature Requires Users to be Registered and Logged In.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
link to top

Content

  • Home
  • Latest
  • Issues
  • Channels
  • CME/MOC
  • In the Clinic
  • Journal Club
  • Web Exclusives

Information For

  • Author Info
  • Reviewers
  • Press
  • Readers
  • Institutions / Libraries / Agencies
  • Advertisers

Services

  • Subscribe
  • Renew
  • Alerts
  • Current Issue RSS
  • Online First RSS
  • In the Clinic RSS
  • Reprints & Permissions
  • Contact Us
  • Help
  • About Annals
  • About Mobile
  • Patient Information
  • Teaching Tools
  • Annals in the News
  • Share Your Feedback

Awards

  • Personae Photography Prize
  • Junior Investigator Awards
  • Poetry Prize

Other Resources

  • ACP Online
  • Career Connection
  • ACP Advocate Blog
  • ACP Journal Wise

Follow Annals On

  • Twitter Link
  • Facebook Link
acp link acp
silverchair link silverchair

Copyright © 2018 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
INSTITUTIONAL SIGN IN
Open Athens|Shibboleth|Log In
Annals of Internal Medicine
PURCHASE OPTIONS
Buy This Article|Subscribe
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Sign in below to access your subscription for full content
INDIVIDUAL SIGN IN
Sign In|Set Up Account
You will be directed to acponline.org to register and create your Annals account
Annals of Internal Medicine
CREATE YOUR FREE ACCOUNT
Create Your Free Account|Why?
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×