RESUMO
INTRODUCTION: In 2011, Medicare began offering annual preventive care visits (annual wellness visit; AWV) to beneficiaries at no charge. Providing free preventive care supports primary and secondary prevention of chronic disease and may reduce ethnoracial disparities in health outcomes. OBJECTIVES: To estimate AWV utilization trends by ethnoracial group in a nationally representative sample of the Medicare population. RESEARCH DESIGN: We estimated the probability of AWV utilization using probit regression models with beneficiary-reported ethnoracial group as the primary predictor and demographics, socioeconomic indicators, and factors related to access and utilization of health care as covariates. SUBJECTS: In total, 14,687 fee-for-service Medicare beneficiaries aged 66 years or older who participated in the Medicare Current Beneficiary Survey 2011-2013. MEASURES: AWV utilization was identified using procedure codes. RESULTS: Overall AWV utilization increased from 8.1% (2011) to 13.4% (2013). In 2011, utilization was highest in non-Hispanic white (8.5%) and lowest in non-Hispanic black (4.5%) beneficiaries. Utilization increased the most in non-Hispanic black beneficiaries, to 15.4% in 2013. Significant differences in AWV utilization by non-Hispanic black and Hispanic/Latino beneficiaries were found in unadjusted models, but did not persist after controlling for income and education. Having a usual (nonemergent) place of care and a nonrural residence were strong predictors of utilization. CONCLUSIONS: Utilization of the AWV has increased modestly since its introduction, but remains low. Utilization varies by ethnoracial group, with disparities largely explained by differences in income and education. Further efforts are needed to evaluate AWV utilization and effectiveness, especially among low socioeconomic status ethnoracial minorities.
Assuntos
Etnicidade/estatística & dados numéricos , Medicare/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Planos de Pagamento por Serviço Prestado , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Assistência Centrada no Paciente/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Estados UnidosRESUMO
OBJECTIVE: The menopausal transition is associated with somatic symptoms and increased rates of depression, which can impair quality of life (QOL) and increase cardiovascular disease (CVD) risk. This period is also associated with accelerated vascular aging (arterial stiffening and endothelial dysfunction), an antecedent to CVD. This secondary analysis sought to explore associations between depression, menopausal symptoms and QOL, and vascular aging across menopause stages. METHODS: Arterial stiffness (carotid artery compliance), endothelial function (brachial artery flow-mediated dilation [FMD]), menopausal symptoms (Menopausal Symptom List [MSL]), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and QOL (Utian QOL Scale [UQOL]) were measured in 138 women (19-70 years) classified as premenopausal (nâ=â41, 34â±â8 years; meanâ±âSD), early (nâ=â25, 49â±â3 years), or late perimenopausal (nâ=â26, 50â±â4 years), or early (nâ=â22, 55â±â4 years) or late postmenopausal (nâ=â24, 61â±â5 years). Differences across menopause stages were determined using one-way analysis of variance; associations between vascular measures and MSL, CES-D, and UQOL were tested using Pearson's correlation analyses. RESULTS: Menopausal symptoms, depression, and QOL worsened across menopause stages, particularly in late perimenopausal women. Vasosomatic symptom frequency, and general somatic symptom frequency and severity were inversely correlated with carotid artery compliance and FMD (râ=â-0.27 to -0.18, all Pâ<â0.05). Only correlations with general somatic symptoms were significant after adjusting for multiple comparisons. Total QOL was positively correlated with carotid artery compliance (râ=â0.23, Pâ=â0.01). CES-D scores were not correlated with carotid artery compliance or FMD (râ=â-0.08, -0.03, Pâ=â0.35). CONCLUSIONS: Vascular dysfunction across the stages of menopause was associated with greater frequency and severity of menopausal symptoms, and lower QOL, but not depression. Mechanisms underlying these associations (eg, inflammation, oxidative stress) should be explored.
Assuntos
Depressão/fisiopatologia , Endotélio Vascular/fisiologia , Menopausa/fisiologia , Qualidade de Vida , Rigidez Vascular/fisiologia , Adulto , Afeto/fisiologia , Idoso , Análise de Variância , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiologia , Doenças Cardiovasculares/etiologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiologia , Complacência (Medida de Distensibilidade) , Depressão/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Ultrassonografia , Vasodilatação , Adulto JovemRESUMO
OBJECTIVE: It is unclear how changes in ovarian hormones during the menopausal transition contribute to age-associated arterial stiffening. We sought to evaluate differences in arterial stiffness and the role of oxidative stress across the stages of the menopausal transition in healthy women. METHODS: Arterial stiffness (carotid artery compliance and ultrasound) was measured during immediate infusions of saline (control) and ascorbic acid (experimental model to immediately decrease oxidative stress) in 97 healthy women (22-70 y) classified as premenopausal (n = 24; mean [SD] age, 33 [7] y), early perimenopausal (n = 21; 49 [3] y) or late perimenopausal (n = 21; 50 [4] y), or postmenopausal (n = 31; 57 [5] y). RESULTS: Basal carotid artery compliance was different among the groups (P < 0.001). Mean [SD] compliance was highest in premenopausal women (1.31 [0.25] mm/mm Hg × 10), with progressive decrements in perimenopausal (early perimenopausal, 0.98 [0.31] mm/mm Hg × 10; late perimenopausal, 0.90 [0.25] mm/mm Hg × 10) and postmenopausal (0.75 [0.24] mm/mm Hg × 10) women. Ascorbic acid infusion improved compliance in late perimenopausal (15% [18%] increase, P = 0.001) and postmenopausal (17% [26%] increase, P = 0.002) women but not in early perimenopausal or premenopausal women. CONCLUSIONS: Arterial stiffening worsens across the stages of the menopausal transition in healthy women. This seems to be mediated, in part, by oxidative stress, particularly during the late perimenopausal and postmenopausal periods. It remains uncertain whether this is specifically caused by loss of ovarian function or aging.