Relationship Between CVD, Income and Health care Access in

Indiana and US Populations.

Rachel L. Ostendorf, BS. Monica N. Sanchez, BS. Holly B. Zabrin, BS. & Brandon M. Kistler, PhD, RD
Department of Nutrition and Health Science, Ball State University, Muncie, IN

ABSTRACT AIM Figure 2. Percentages Compared Using BRFSS DISCUSSION

Results in Relation to Income and Cardiovascular
Disease in the US and IN. The There is a relationship between income level, health care
US

Calculated % of people with CVD

Cardiovascular disease (CVD) is the leading cause To evaluate the impact of income and access to 16
15 Chi-square value: 632.54 access and the prevalence of cardiovascular disease (CVD) in
of death in the US. Populations with low income and healthcare to the prevalence of Cardiovascular Disease in the U.S. 14
13
P-value: <0.0001 both the U.S and Indiana.
inadequate healthcare access have been shown to have a population compared to individuals in IN. 12 IN There is a higher risk of CVD in lower income populations.
11
greater risk of CVD. Lower income rural areas in Indiana 10
Chi-square value: 23.35
P-value: 0.0007 When compared to the U.S., IN showed a 5% greater risk of
Hypothesis: There is a relationship between income levels of 9
CVD.
have shown limited access to health care. Objective: 8
individuals with no health care access and the prevalence of heart 7
IN had the highest prevalence of CVD when comparing health
Therefore we tested the relationship between income level, 6

health care access, and a diagnosis of CVD among Indiana

disease in the U.S. and IN. 5 care and income levels.
4

and US adults. Methods: Data from the 2015 Behavioral Risk
Factor Surveillance System (BRFSS) was analyzed using a
Chi Squared (X2) analysis. Statistical significance was
determined as p<0.005 to account for multiple comparisons.
Results: CVD and income were related in both the U.S. (x2 of
633, p<0.0001) and IN (x2 of 25.35, p<0.0007) with the
highest incidence of CVD at an income between $10,000-
$15,000. There was also a significant relationship between
CVD and health care coverage among US (p<0.0001) but not
IN adults (p<0.013). Among US adults with health care access
(p<0.0001), but not those who lack healthcare access
3 Researchers found that Southern IN has greater economic
2
1 hardships than other regions of the U.S.
METHODS 0
Income < $10,000 <= $15,000 <= $20,000 <= $25,000 <= $35,000 <= $50,000 <= Income >=
$10,000 Income < Income < Income < Income < Income < Income < $75,000
Lower socioeconomic status is correlated to lower access to
treatment and lower access to health care. Low socioeconomic
$15,000 $20,000 $25,000 $35,000 $50,000 $75,000
status is correlated with higher incidence of CVD.
Income Level
Study Type: Survey method implemented by telephone interview There is a large deficit in adequate access to health care in the
US IN
U.S. The cost of health care continues to rise.
Data Source: Behavioral Risk Factors Surveillance System
(BRFSS) 2015. The BRFSS is supported by the CDC and
measures behavioral risk factors for the adult population (18 years Figure 3. BRFSS Comparisons in the US and IN: IMPLICATIONS
or older) living in households. Those Diagnosed with Cardiovascular Disease in
Relation to Income and Health Care Access. Those with an income ranging between $10,000-$15,000 had
Participants: Random sample of adults (18 years or older) in the

Percentage of people with CVD

(p=0.0118), there was a significant relationship between CVD U.S. and IN.
17
16 US the highest cases of CVD. IN has a 5% higher risk compared
and income. Discussion: In conclusion, we found a 15
14
Chi-square value: 630.87
to the US.
significant relationship between access to healthcare and CVD Variables Analyzed: 13
P-value: <0.0001
12 When comparing access to health care and income, the
in US, but not IN adults. Additionally, we found a significant Income level in comparison to heart disease 11
10
IN
Chi-square value: 27.85 highest prevalence of CVD in both the US and IN fell within
P-value: 0.0002
relationship between income and CVD in both US and IN Income level in comparison to heart disease in relation to 9
8 the same income group. In contrast, those in IN with no
adults. When separated by access to health care, the access to healthcare
7
6 access to healthcare were not comparable due to the limited
relationship between income and CVD remained only among 5 data representing this population.
those with access to healthcare. Understanding inequality of Healthcare coverage in comparison to heart disease 4
3
2 Health care access was related to CVD in both IN and the US.
health care access among varied income levels could provide Data Analysis: Chi-Square (2) test was used to evaluate the data. 1
0 However, when the U.S is compared to IN, IN has a higher
prospective recommendations for those with CVD. Statistical significance was set at p < 0.01 after performing a Income < $10,000 <= $15,000 <= $20,000 <= $25,000 <= $35,000 <= $50,000 <= Income >=
$10,000 Income < Income < Income < Income < Income < Income < $75,000 prevalence of CVD.
Bonferroni Correction $15,000 $20,000 $25,000 $35,000 $50,000 $75,000
Current BRFFS statistics report IN residents have an
Income Level increased chance of developing CVD, compared to US
BACKGROUND US- Have Access to Health Care residents.
RESULTS US- No Access to Health Care
IN- Have Access to Health Care

An individuals risk of CVD depends not only on biological and REFERENCES

environmental factors, but also depends on geographical factors.
Figure 1. BRFSS Results: Comparing Percentage of
According to the CDC, those who live in Southeastern states tend Figure 4. Percentages of People with 1. Kirby JB. Poor people, poor places and access to health care in the
People in the US and IN with Cardiovascular Disease
to have a higher risk of CVD. Northwestern states tend to have a Cardiovascular Disease with and without Health United States. Social Forces. 2008;87:325-355.
lower risk of CVD. Care Access in the US and IN. 2. Schroder S, Richter M, Schroder J, Frantz S, Fink A. Socioeconomic
9 inequalities in access to treatment for coronary heart disease: A
The states with the highest risk of CVD in 2010 were the systematic review. International Journal of Cardiology. 2016;219:70-
Percentage of people with CVD
8
78.
IN and US Populations

following in order of high to low: Kentucky, West Virginia,

7 US 3. Rehkopf DH, Krieger N, Coull B, Berkman LF. Biologic risk markers
Louisiana, Oklahoma, Alabama, Mississippi, Arkansas, Michigan, IN Chi-square value: 353.15
for coronary heart disease: nonlinear associations with income.
Indiana, and Tennessee. 6 P-value: <0.0001
Epidemiology. 2010;21:38-46.
The prevalence of CVD is also highly correlated with income 5 IN
Chi-square value: 6.16
4. Pabayo R, Kawachi I, Gilman SE. US State-level income inequality and
level, socioeconomic status and access to health care. Access to 4 P-value: 0.013
risks of heart attack and coronary risk behaviors: longitudinal findings.
International Journal of Public Health. 2015;60:573-588.
health care is currently a hot topic in the U.S. and many U.S. 3
5. Martin TF, II. The stark inaccessibility of medical care in rural Indiana:
citizens are worried about the future of our country. US
2 judicial and legislative solutions. Indiana Health Law Review.
The decisions that our government will make, and the laws and 1
2014;11:831.
6. Lewis MW, Khodneva Y, Redmond N, et al. The impact of the
regulations that will be set in place will affect each U.S. citizen. 0 combination of income and education on the incidence of coronary heart
0 1 2 3 4 5 6 7 8
The results of this study may help shed light on the topic and US IN disease in the prospective Reasons for Geographic and Racial
provide a deeper insight on the importance of health care access Percentage of People with Cardiovascular Disease Do Have Access to Health Care Do Not Have Access to Health Care Differences in Stroke (REGARDS) cohort study. BMC Public Health.
2015;15.
in relation to CVD.