Uninsured patients represent an understudied population. The current study aimed to estimate the burden of 10 common chronic conditions and to investigate the associated factors among patients who use free clinics for their health care needs.
Methods
Patient charts from four free clinics were reviewed from January to December of 2015. Proportion of prevalence, adjusted odds ratios (AOR), and 95% confidence intervals (CI) for associations between participant characteristics and chronic conditions are reported.
Results
Prevalence of hypertension and hyperlipidemia significantly differed by clinic, age, gender, race, and marital status. Compared to age 15–44 years, older patients (45–64 years, and ≥65) were 5–10 times more likely to suffer from hypertension. Compared to women, men; compared to White, African-Americans; and compared to single, married patients had higher prevalences of hypertension. Older patients were 5–8 times more likely to suffer from hyperlipidemia. Asians, and married patients were also more likely to experience hyperlipidemia. Prevalence of diabetes, depression and arthritis significantly differed by age and race. Prevalence of coronary artery disease and chronic obstructive pulmonary disease increased 6–13 folds among older patients.
Discussion
Patients of free clinics suffer from high burden of chronic conditions. Patients who frequent free clinics are primarily older, unemployed, women, minorities, and are of low income.
ButtorffCRuderTBaumanM.Multiple chronic conditions in the United States.
Santa Monica, CA:
RAND Corporation, 2017.
2.
Statistics NCfH Health, United States, 2016: with chartbook on long-term trends in health. 2017.
3.
RogerVLGoASLloyd-JonesDM, et al.
Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation2011;
123: e18–e209.
4.
Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care2013; 36: 1033–1046.
5.
WillettWKoplanJNugentR, et al.Prevention of chronic disease by means of diet and lifestyle changes (Table 44.2). Disease control priorities in developing countries.
New York and Washington, DC:
Oxford University Press and the World Bank, 2006.
6.
CarrollMDKitBKLacherDA. Total and high-density lipoprotein cholesterol in adults: National Health and Nutrition Examination Survey, 2009-2010. NCHS data brief, 2012, pp. 1–8.
7.
AkinbamiOJMoormanJEBaileyC, et al. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. 2012.
The HenryJ.Kaiser Family Foundation. Health insurance coverage of the total population.
Menlo Park, CA:
Kaiser Family Foundation, 2013.
10.
National Association of Free & Charitable Clinics. America’s free and charitable clinics: vital support for 30 million uninsured Americans.
Alexandria, VA:
NAFC, 2014.
11.
GarfieldRDamicoAStephensJ, et al. The coverage gap: uninsured poor adults in states that do not expand Medicaid–an update.
Menlo Park, CA:
Kaiser Family Foundation, 2016.
12.
GoodmanRAPosnerSFHuangES, et al.
Defining and measuring chronic conditions: imperatives for research, policy, program, and practice. Prev Chronic Dis2013;
10: E66.
13.
PrasadSSungBAggarwalBB.Age-associated chronic diseases require age-old medicine: role of chronic inflammation. Prev Med2012;
54: S29–S37.
14.
BujaADamianiGGiniR, et al.
Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required. Plos One2014;
9: e91340.
15.
AyanianJZWeissmanJSSchneiderEC, et al.
Unmet health needs of uninsured adults in the United States. JAMA2000;
284: 2061–2069.
16.
Health insurance coverage and receipt of preventive health services–United States, 1993. MMWR Morb Mortal Wkly Rep1995; 44: 219–225.
17.
EganBMLiJHutchisonFN, et al.
Hypertension in the United States 1999-2012: progress toward Healthy People 2020 goals. Circulation2014;
130: 1692–1699.
18.
MenkeACasagrandeSGeissL, et al.
Prevalence of and trends in diabetes among adults in the united states, 1988-2012. JAMA2015;
314: 1021–1029.
19.
JohnsonNBHayesLDBrownK, et al. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005–2013. 2014.
20.
Control CfD and Prevention.
Current depression among adults—United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep2010;
59: 1229.
21.
PrattLABrodyDJ.Depression and obesity in the US adult household population, 2005–2010. Women2014;
20: 39.
22.
LiuXRodriguezCJWangK.Prevalence and trends of isolated systolic hypertension among untreated adults in the United States. J Am Soc Hypertens2015;
9: 197–205.
23.
BarbourKE.Vital signs: prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2013–2015. MMWR Morb Mortal Wkly Rep2017;
66: 246–253.
24.
HootmanJMHelmickCGBarbourKE, et al.
Updated projected prevalence of self‐reported doctor‐diagnosed arthritis and arthritis‐attributable activity limitation among US adults, 2015–2040. Arthritis Rheumatol2016;
68: 1582.
25.
Centers for Disease Control and Prevention.
Prevalence of coronary heart disease–United States, 2006-2010. MMWR Morb Mortal Wkly Rep2011;
60: 1377.
26.
ZhangXHoltJBLuH, et al.
Multilevel regression and poststratification for small-area estimation of population health outcomes: a case study of chronic obstructive pulmonary disease prevalence using the behavioral risk factor surveillance system. Am J Epidemiol2014;
179: 1025–1033.
MerikangasKRMcClairVL.Epidemiology of substance use disorders. Hum Genet2012;
131: 779–789.
29.
DzauVJAntmanEMBlackHR, et al.
The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: part I: pathophysiology and clinical trial evidence (risk factors through stable coronary artery disease). Circulation2006;
114: 2850–2870.
30.
NarayanKVBoyleJPThompsonTJ, et al.
Lifetime risk for diabetes mellitus in the United States. JAMA2003;
290: 1884–1890.
31.
FerrucciLGiallauriaFGuralnikJM.Epidemiology of aging. Radiol Clin North Am2008;
46: 643–645.
32.
GurvenMKaplanHWinkingJ, et al.
Aging and inflammation in two epidemiological worlds. J Gerontol A Biol Sci Med Sci2008;
63: 196–199.
33.
ChandraRK.Nutrition and the immune system from birth to old age. Eur J Clin Nutr2002;
56: S73.
34.
LevensonRWCarstensenLLFriesenWV, et al.
Emotion, physiology, and expression in old age. Psychol Aging1991;
6: 28.
35.
AlamanosYDrososAA.Epidemiology of adult rheumatoid arthritis. Autoimmun Rev2005;
4: 130–136.
36.
SandbergKJiH.Sex differences in primary hypertension. Biol Sex Differ2012;
3: 7.
37.
KvienTKUhligTOdegardS, et al.
Epidemiological aspects of rheumatoid arthritis: the sex ratio. Ann N Y Acad Sci2006;
1069: 212–222.
38.
BradyKTRandallCL.Gender differences in substance use disorders. Psychiatr Clin North Am1999;
22: 241–252.
39.
WindleM.A longitudinal study of antisocial behaviors in early adolescence as predictors of late adolescent substance use: gender and ethnic group differences. J Abnormal Psychol1990;
99: 86.
HertzRPUngerANCornellJA, et al.
Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med2005;
165: 2098–2104.
42.
PeekMECargillAHuangES.Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev2007;
64: 101S–156S.
43.
UrsuaRAguilarDWyattL, et al.
Awareness, treatment and control of hypertension among filipino immigrants. J Gen Intern Med2014;
29: 455–462.
44.
FrankATHZhaoBJosePO, et al.
Racial/ethnic differences in dyslipidemia patterns. Circulation2014;
129: 570–579.
45.
GrahamG.Population-based approaches to understanding disparities in cardiovascular disease risk in the United States. Int J Gen Med2014;
7: 393–400.
46.
Kiecolt-GlaserJKNewtonTL.Marriage and health: his and hers. Psychol Bull2001;
127: 472–503.
47.
ManzoliLVillariPGMP, et al.
Marital status and mortality in the elderly: a systematic review and meta-analysis. Soc Sci Med2007;
64: 77–94.
48.
WaiteLJLehrerEL.The benefits from marriage and religion in the United States: a comparative analysis. Popul Dev Rev2003;
29: 255–276.
49.
SchwandtHMCoreshJHindinMJ.Marital status, hypertension, coronary heart disease, diabetes, and death among African American women and men: incidence and prevalence in the Atherosclerosis Risk in Communities (ARIC) study participants. J Fam Issues2010;
31: 1211–1229.
50.
GrottoIHuertaMSharabiY.Hypertension and socioeconomic status. Curr Opin Cardiol2008;
23: 335–339.
51.
McGeeREThompsonNJ.Peer reviewed: unemployment and depression among emerging adults in 12 states, Behavioral Risk Factor Surveillance System, 2010. Prev Chronic Dis2015;
12: 1–11.
WheatonAGCunninghamTJFordES, et al.
Employment and activity limitations among adults with chronic obstructive pulmonary disease–United States. MMWR Morb Mortal Wkly Rep 2015. 2013;
64: 289–295.
54.
DarnellJS.Free clinics in the United States: a nationwide survey. Arch Intern Med2010;
170: 946–953.
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