The COVID-19 pandemic was associated with increased hypertension treatment rates among low-income adults (+7.8 percentage points) but worsened glycemic control (-8.7 percentage points).
Cross-Sectional (n=62,108)
Yes
While post-pandemic treatment rates for hypertension and high cholesterol improved among low-income US adults, glycemic and cholesterol control worsened, highlighting the need for targeted interventions to address income-based disparities.
Abstract Background Cardiovascular (CV) mortality is rising in the US, and low-income adults bare a greater burden of CV risk factors than their higher-income counterparts. The COVID-19 pandemic threatened to widen these disparities, but relief policies expanding healthcare access 200% of the federal poverty level. CV risk factors (hypertension, diabetes, high cholesterol, obesity, and smoking) were defined by clinical guidelines (Table). We estimated age- and sex- adjusted prevalence, treatment, and control rates from 2009-2023, and used linear probability models and Wald tests to assess pandemic-related changes. A significant "level-shift" indicated that the post-pandemic values deviated from pre-pandemic trends. Results Of the 62,108 adults (weighted mean age 46.3 years; 52% female), 28,598 were low-income. Hypertension prevalence, treatment and control were stable from 2009-2023, but post-pandemic, prevalence declined more than expected (level shift -3.1 percentage points 95% CI -5.8 ,-0.5) and treatment rates increased, driven by gains among low-income adults (+7.8 1.8, 13.8). Diabetes prevalence rose from 10.8% in 2009 to 14.1% in 2023, and post-pandemic, glycemic control declined sharply among low-income adults (-8.7 -16.7, -0.6). High cholesterol prevalence, treatment, and control improved from 2009-2023, but despite post-pandemic treatment gains (+5.8 1.6, 10.1 for low-income adults), control rates declined (-3.9 -7.4, -0.5). Obesity increased steadily, while smoking rates declined, with no significant pandemic-related shifts (Table, Figure). Conclusion Between 2009-2023, lipid management improved but diabetes prevalence rose among US adults. Post-pandemic, treatment rates for high cholesterol and hypertension increased, particularly among low-income adults, likely due to expansions in telehealth, mail-order pharmacies, and insurance coverage. However, cholesterol control rates declined and glycemic control worsened among low-income adults, possibly due to pandemic-related disruptions in health behaviors and A1c & lipid monitoring. As pandemic-era policies end, targeted interventions will be critical for sustaining treatment gains, restoring control rates, and addressing income-based disparities in diabetes management.Table Figure
Marinacci et al. (Sat,) conducted a cross-sectional in Cardiovascular risk factors (n=62,108). COVID-19 pandemic vs. Pre-pandemic trends was evaluated on Changes in cardiovascular risk factor prevalence, treatment, and control. The COVID-19 pandemic was associated with increased hypertension treatment rates among low-income adults (+7.8 percentage points) but worsened glycemic control (-8.7 percentage points).