Association of Health Professional Shortage Areas and Cardiovascular Risk Factor Prevalence, Awareness, and Control in the Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND- Individuals living in primary care health professional shortage areas (PC-HPSA), often have difficulty obtaining medical care; however, no previous studies have examined association of pc-hpsa residence with prevalence of cardiovascular disease risk factors. METHODS AND RESULTS- To examine this question, the authors used data from the Multi-Ethnic Study of Atherosclerosis baseline examination (2000-2002). Outcomes included the prevalence of diabetes, hypertension, hyperlipidemia, smoking, and obesity as well as the awareness and control of diabetes, hypertension, and hyperlipidemia. Multivariable Poisson models were used to examine the independent association of PC-HPSA residence with each outcome. Models were sequentially adjusted for demographics, acculturation, socioeconomic status, access to health care, and neighborhood socioeconomic status. Similar to the national average, 16.7% of Multi-Ethnic Study of Atherosclerosis participants lived in a PC-HPSA. In unadjusted analyses, prevalence rates of diabetes (14.8% versus 11.0%), hypertension (48.2% versus 43.1%), obesity (35.7% versus 31.1%), and smoking (15.5% versus 12.1%) were significantly higher among residents of PC-HPSAs. There were no significant differences in the awareness or control of diabetes, hypertension, or hyperlipidemia. After adjustment, residence in a PC-HPSA was not independently associated with cardiovascular disease risk factor prevalence, awareness, or control. CONCLUSIONS- This study suggests that increased prevalence of cardiovascular disease risk factors in PC-HPSAs are explained by the demographic and socioeconomic characteristics of their residents. Future interventions aimed at increasing the number of primary care physicians may not improve cardiovascular risk without first addressing other factors underlying health care disparities.