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Principal Investigator: Rishi Kumar Wadhera
Organization: BETH ISRAEL DEACONESS MEDICAL CENTER
Fiscal Year: 2024
Award: $806,086
Funding agency: National Heart Lung and Blood Institute
PROJECT SUMMARY/ABSTRACT
In the US, working-age adults (age 20 to 64 years) in rural areas experience significantly higher cardiovascular (CV) mortality rates than their urban counterparts due to worse access to care and a greater burden of risk factors. The COVID-19 pandemic threatens to further widen these differences. The pandemic has resulted in enormous delays in outpatient care for chronic conditions, as well as unemployment, economic loss, and disruptions in insurance coverage, all of which have disproportionately affected rural communities. Together, these spillover effects may worsen access to care and increase CV morbidity and mortality long after the pandemic is over. Given these concerns, there is a pressing need to identify policy strategies to improve access to care and health for rural working-age adults in the post-pandemic era. One such strategy that has recently gained substantial public support is to lower the age of eligibility for Medicare. Doing so could have major implications for the CV health of rural working-age adults, whom are more likely to be uninsured and experience barriers in access to care. Telemedicine may be another way to address gaps in care for rural communities, but nearly in 1 in 3 rural persons lack broadband internet access– a significant barrier to telemedicine use. In 2021, the federal government devoted $65 billion to expand broadband in rural communities. It remains unclear whether this substantial investment will improve telemedicine use, access to care, and CV health in rural America. The goal of this proposal is to understand changes in access to care, as well as in the epidemiology of CV risk factors, CV hospitalizations, & deaths among rural working-age adults before and after the pandemic, and to evaluate distinct policy strategies to improve access to care and CV health in rural communities in the post-pandemic era. In Aim 1, we will use a unique combination of national datasets to characterize changes in access to care, as well as in the prevalence of CV risk factors, incidence of CV hospitalizations, and mortality in rural working-age adults, overall and compared with their urban counterparts, in the years that follow the pandemic. In Aim 2, we will determine the effects of Medicare on health care access, screening for CV risk factors, and the treatment & control of CV risk factors in rural working-age adults using a regression discontinuity design. In Aim 3, we will create a new, multidimensional data-source to evaluate if access to medical care, including telemedicine use in the outpatient and hospital settings, and CV outcomes improve in rural communities that expand broadband access using a difference-in-differences analysis. This research will advance our understanding of changes in the CV health of >40 million younger rural adults, in whom the onset of CV risk factors results in substantial loss of years of life. The identification of policies to improve access, preventive care, and treatment for younger rural populations could have major public health implications as the US emerges from the pandemic, and ultimately, improve CV health nationwide.
Terms: <21+ years old><Access to Care><Acute><Address><Adoption><Adult><Adult Human><Affect><Age><Ambulatory Care><American><Apoplexy><BRFSS><Behavior Risk Factor Surveillance System><Behavioral Risk Factor Surveillance System><Biometrics><Biometry><Biostatistics><Brain Vascular Accident><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cardiac infarction><Cardiovascular><Cardiovascular Body System><Cardiovascular Diseases><Cardiovascular Organ System><Cardiovascular system><Caring><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Cessation of life><Cholesterol><Chronic Care><Data><Data Set><Death><Death Rate><Diabetes Mellitus><Economics><Eligibility><Eligibility Determination><Enrollment><Equity><Federal Government><Financial Hardship><Goals><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Health Services Accessibility><Heart Vascular><Heart failure><Hospital Admission><Hospitalization><Hospitals><Hyperlipemia><Hyperlipidemia><Hypertension><Improve Access><Incidence><Inequity><Infrastructure><Inpatients><Insurance Coverage><Insurance Status><Internet><Investments><Jobs><Laboratories><Medical><Medicare><Morbidity><Morbidity - disease rate><Myocardial Infarct><Myocardial Infarction><NHANES><National Government><National Health and Nutrition Examination Survey><Occupations><Out-patients><Outpatient Care><Outpatients><Persons><Policies><Policy Maker><Population><Prevalence><Preventative care><Preventive care><Professional Positions><Protocol Screening><Public Health><Research><Risk Factors><Rural><Rural Community><Rural Health><Rural Hospitals><Rural Population><Rural group><Rural people><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Source><Stroke><Survey Instrument><Surveys><Telemedicine><Title 18><Unemployment><Uninsured><United States><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Visit><WWW><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><adulthood><ages><availability of services><brain attack><cardiac failure><cardiac infarct><cardiovascular disease epidemiology><cardiovascular disorder><cardiovascular disorder epidemiology><cardiovascular epidemiology><cardiovascular health><cardiovascular risk><cardiovascular risk factor><care access><care delivery><cerebral vascular accident><cerebrovascular accident><circulatory system><coronary attack><coronary infarct><coronary infarction><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 pandemic consequence><coronavirus disease 2019 pandemic impact><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><design><designing><diabetes><digital divide><early onset><economic><effects following the COVID-19 pandemic><enroll><experience><falls><financial adversity><financial burden><financial distress><financial insecurity><financial strain><financial stress><health care access><health care availability><health care service access><health care service availability><health insurance for disabled><health service access><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><heart attack><heart infarct><heart infarction><high blood pressure><high dimensional data><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disorder><impact of the SARS-CoV-2 pandemic><improved><improved outcome><insight><jobless><joblessness><life year loss><mortality><mortality rate><mortality ratio><multidimensional data><multidimensional datasets><out of work><outpatient treatment><pandemic><pandemic disease><population health><post-pandemic><preventable death><preventable mortality><programs><rural America><rural area><rural counties><rural individual><rural location><rural region><screening><screenings><service availability><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><stroked><strokes><telestroke><treatment access><unemployed><urban area><urban location><urban region><web><world wide web><years of life lost>