Income disparity and utilization of cardiovascular preventive care services among U.S. adults
Open accessAbstract
OBJECTIVE: : Associations between income disparity and utilization of cardiovascular disease (CVD) preventive care services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without CVD, are not well understood. The purpose of this study was to evaluate associations between income and utilization of CVD-preventive services among U.S. adults. METHODS: : We included adults ≥18 years with and without CVD from the 2006 to 2015 Medical Expenditure Panel Survey. We categorized participants as high-income (>400% of federal poverty level [FPL]), middle income (200-400% of FPL), low-income (125-200% of FPL) and very low (VL)-income (<125% of FPL). We used logistic regression to compare the likelihood of receiving CVD-preventive services by income strata, adjusting for sociodemographic factors and comorbidities. RESULTS: : The study included 185,081 participants (representing 194.6 million U.S. adults) without CVD, and 32,862 participants (representing 37 million U.S. adults) with CVD. VL-income adults without CVD were less likely than high-income adults to have blood pressure measured within past 2 years [odds ratio [OR] 0.41 (95% confidence interval [CI] 0.37-0.45)] or cholesterol levels checked within past 5 years [0.36 (0.33-0.38)] or receive counseling about diet modifications [0.77 (0.74-0.81)], exercise [0.81 (0.77-0.85)], or smoking cessation [0.71 (0.63-0.79)] within past year. VL-income adults with CVD were also less likely to have blood pressure [0.32 (0.22-0.46)] or cholesterol [0.33 (0.26-0.42)] checked and receive counseling about exercise [0.84 (0.76-0.93)] or smoking cessation [0.78 (0.61-0.99)]. Additional subgroup analyses restricted to participants who had seen a healthcare provider within the preceding 12 months, as well as secondary analyses stratified by sex, race and ethnicity, showed similar disparities between high-income and VL-income participants. CONCLUSIONS: : VL-income adults were less likely to be screened for CVD risk factors or receive CVD-prevention counseling than high-income adults, regardless of CVD status. More work must be done to reduce disparities in access to and utilization of CVD-preventive services among adults in different income groups.
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Written from the paper’s full text.
TL;DR
In a nationally representative MEPS sample from 2006–2015, low- and very-low-income U.S. adults were significantly less likely than high-income adults to receive cardiovascular preventive services, regardless of CVD status. Disparities largely persisted after adjustment and among those who had seen a provider in the past year, though some subgroup estimates were no longer statistically significant.
Key findings
- Among participants without CVD, adjusted odds for low- and very-low-income vs high-income adults were lower for smoking cessation counseling [OR 0.70 (95% CI 0.62–0.79) and OR 0.71 (0.63–0.79)], BP checked within 2 years [OR 0.45 (0.42–0.49) and OR 0.41 (0.37–0.45)], exercise counseling [OR 0.79 (0.75–0.84) and OR 0.81 (0.77–0.85)], dietary counseling [OR 0.77 (0.73–0.81) and OR 0.77 (0.74–0.81)], and cholesterol checked within 5 years [OR 0.42 (0.39–0.45) and OR 0.36 (0.33–0.38)].
- Among participants with CVD, adjusted odds for low- and very-low-income vs high-income adults were lower for smoking cessation counseling [OR 0.64 (0.48–0.86) and OR 0.78 (0.61–0.99)], BP checked within 2 years [OR 0.34 (0.24–0.49) and OR 0.32 (0.22–0.46)], exercise counseling [OR 0.79 (0.71–0.87) and OR 0.84 (0.76–0.93)], and cholesterol checked within 5 years [OR 0.34 (0.28–0.42) and OR 0.33 (0.26–0.42)]; dietary counseling was lower for low-income [OR 0.84 (0.76–0.93)] but not very-low-income [OR 0.95 (0.86–1.04)] participants.
- In the subgroup restricted to participants who visited a provider within the past year, disparities mostly persisted; for example, without CVD, BP check ORs were 0.65 (0.56–0.75) and 0.65 (0.56–0.77), and cholesterol check ORs were 0.57 (0.52–0.62) and 0.55 (0.50–0.61) for low- and very-low-income adults. With CVD, exercise counseling ORs were 0.70 (0.62–0.79) and 0.67 (0.60–0.74), and cholesterol check ORs were 0.54 (0.40–0.73) and 0.44 (0.31–0.61).
Methods
- Retrospective observational study using Medical Expenditure Panel Survey (MEPS) data from 2006–2015; after exclusions, the sample included 185,081 participants without CVD (representing 194 million U.S. adults) and 32,862 with CVD (representing 37 million U.S. adults).
- Income was categorized as high (>400% federal poverty level [FPL]), middle (200–400% FPL), low (125–200% FPL), or very low (<125% FPL). Outcomes were self-reported smoking cessation counseling, BP checked within 2 years, exercise counseling, dietary counseling, and cholesterol checked within 5 years.
- Analyses used χ² tests and multivariable logistic regression with high-income as reference, adjusted for age, race/ethnicity, sex, region, health insurance, educational status, and Charlson Comorbidity Index; subgroup analyses were restricted to those who visited a provider within the prior 12 months, with secondary analyses stratified by sex, race, and ethnicity.
Limitations
- Stated: MEPS relies on self-report, so recall bias may lead to underestimating CVD history or misreporting service use; income is intertwined with race/ethnicity, education, and insurance; observational design cannot establish causality and residual confounding is possible; low-income participants were more likely to be Black or Hispanic, uninsured, and less educated; very-low-income participants were younger; regional residual confounding may remain due to lack of granular geographic data; and visit regularity could not be fully adjusted for despite subgroup analysis.
- Evident: the cross-sectional design cannot establish temporal ordering between income and receipt of preventive services, and the study relies on survey responses rather than clinical verification of services.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
15 of 34 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Individuals of lower SES have worse cardiovascular outcomes, such as CVD-related mortality.
“Individuals of lower SES have worse cardiovascular outcomes, such as CVD-related mortality [7].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [7] Stringhini, 2017, Socioeconomic status and the 25×25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1.7 million men and women, Lancet source
- Premisereasoning
MEPS offers a nationally representative U.S. sample.
“Because person-level weighting and variance estimation were used to account for survey nonresponse and national population characteristics, MEPS offers a nationally representative U.S. sample.”
Quote in the paperSubstantial claim2 of 4 sources checked- cites [14] "Medical Expenditure Panel Survey." Accessed May 29, 2021 http://meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [15] Cohen, 1996, The Medical Expenditure Panel Survey: a national health information resource, Inquiry
- cites [16] Tibuakuu, 2020, Nondietary cardiovascular health metrics with patient experience and loss of productivity among US adults without cardiovascular disease: the medical expenditure panel survey 2006 to 2015, J Am Heart Assoc source
- cites [17] Okunrintemi, 2020, Age-specific differences in patient reported outcomes among adults with atherosclerotic cardiovascular disease: medical expenditure panel survey 2006–2015, Am J Prev Cardiol source
- Premisecitation
Lower individual and neighborhood-level SES are associated with increased incidence and prevalence of CVD, including coronary heart disease, heart failure and stroke.
“Lower individual and neighborhood-level SES are associated with an increased incidence and prevalence of CVD, including coronary heart disease, heart failure and stroke [1,[3], [4], [5], [6]].”
Quote in the paperNot a substantial claim3 of 3 sources checked- cites [1] White-Williams, 2020, Addressing social determinants of health in the care of patients with heart failure: a scientific statement from the American Heart Association, Circulation source
The Clinical Statements and Guidelines section (page unavailable) says lower socioeconomic position is associated with worse outcomes in patients with heart failure and identifies low SES as a contributor to higher heart-failure risk in one comparison. It does not establish the claimed association between both individual- and neighborhood-level SES and the incidence and prevalence of CVD across coronary heart disease, heart failure, and stroke. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [3] Carlsson, 2016, Neighbourhood socioeconomic status and coronary heart disease in individuals between 40 and 50 years, Heart source
The Conclusions (page not available in our copy) report increased risk of premature myocardial infarction and coronary heart disease among younger middle-aged Swedes in lower-SES neighbourhoods, independent of measured individual socioeconomic factors. The Introduction says individual and neighbourhood SES shape cardiovascular risk factors, but the paper does not establish the claimed associations with CVD prevalence, heart failure or stroke, or a separate increase in CVD incidence associated with lower individual SES. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [4] Reshetnyak, 2020, Impact of multiple social determinants of health on incident stroke, Stroke source
The Results report that income, education, and zip-code poverty were associated with incident stroke, with higher stroke risk as the number of social determinants increased among adults under 75. The paper does not report increased coronary heart disease or heart failure incidence or prevalence, nor stroke prevalence, so it supports only the stroke-incidence portion of the broader CVD claim. (LLM, conf=0.90)
Experimental — accuracy not yet measured
- Findingown data
Low-income participants without CVD who smoked were less likely to be advised to quit smoking than high-income participants (OR 0.70, 95% CI 0.62-0.79).
“Low- and VL-income participants who smoked were less likely to be advised to quit smoking than high-income participants [OR 0.70 (95% CI, 0.62–0.79) and OR 0.71 (0.63–0.79), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
A greater share of VL-income participants was in the youngest (18-39 years) age category.
“Notably, a greater share of VL-income participants was in the youngest (18–39 years) age category.”
Quote in the paperNot a substantial claim
- Findingown data
Among individuals with CVD who visited a provider within the past year, low- and VL-income participants were less likely to have had their cholesterol checked within the last 5 years (OR 0.54 [0.40-0.73] and OR 0.44 [0.31-0.61]).
“Low- and VL-income participants were less likely to have had their cholesterol checked within the last 5 years [OR 0.54 (0.40–0.73) and OR 0.44 (0.31–0.61), respectively].”
Quote in the paperSubstantial claim - Findingown data
Low-income participants with CVD were less likely to have had their BP measured within the last 2 years than high-income participants (OR 0.34, 95% CI 0.24-0.49).
“Low- and VL-income participants were less likely to have had their BP measured within the last 2 years [OR 0.34 (0.24–0.49) and OR 0.32 (0.22–0.46), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants without CVD were less likely to receive dietary counseling than high-income participants (OR 0.77, 95% CI 0.73-0.81).
“Low- and VL-income participants were less likely to receive dietary counseling [OR 0.77 (0.73–0.81) and OR 0.77 (0.74–0.81), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Among individuals with CVD who visited a provider within the past year, low- and VL-income current smokers trended less likely to receive smoking cessation counseling than high-income counterparts, though the results were not statistically significant (OR 0.74 [0.53-1.04] and OR 0.87 [0.61-1.26]).
“Low- and VL-income participants who smoked trended less likely to receive smoking cessation counseling than their high-income counterparts, though results were not statistically significant [OR 0.74 (0.53–1.04) and OR 0.87 (0.61–1.26), respectively].”
Quote in the paperNot a substantial claim - Findingown data
VL-income participants without CVD were less likely to receive dietary counseling than high-income participants (OR 0.77, 95% CI 0.74-0.81).
“Low- and VL-income participants were less likely to receive dietary counseling [OR 0.77 (0.73–0.81) and OR 0.77 (0.74–0.81), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Among individuals with CVD who visited a provider within the past year, low- and VL-income participants were less likely to have had their blood pressure measured within the last 2 years (OR 0.45 [0.26-0.77] and OR 0.47 [0.27-0.82]).
“Low- and VL-income participants were less likely to have had their BP measured within the last 2 years [OR 0.45 (0.26–0.77) and OR 0.47 (0.27–0.82), respectively].”
Quote in the paperSubstantial claim - Findingown data
Low-income participants with CVD were less likely to receive exercise counseling than high-income participants (OR 0.79, 95% CI 0.71-0.87).
“Low- and VL-income participants were less likely to receive exercise counseling [OR 0.79 (0.71–0.87) and OR 0.84 (0.76–0.93), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants without CVD were less likely to have had their cholesterol checked within the last 5 years than high-income participants (OR 0.42, 95% CI 0.39-0.45).
“Low- and VL-income participants were less likely to have had their cholesterol checked within the last 5 years [OR 0.42 (0.39–0.45) and OR 0.36 (0.33–0.38), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
In a large, cross-sectional and nationally representative sample of U.S. adults, there was significant disparity in utilization of CVD risk-related preventive services among participants of differing individual socioeconomic status.
“In a large, cross-sectional and nationally representative sample of U.S. adults, we observed significant disparity in utilization of CVD risk-related preventive services among participants of differing individual SES.”
Quote in the paperSubstantial claim - Findingown data
Regardless of race (non-Hispanic White, Black or Asian) or ethnicity (Hispanic), low- and VL-income participants were less likely to utilize or receive CVD risk preventive services than their high-income counterparts.
“Similarly, regardless of their race (non-Hispanic White, Black or Asian) or ethnicity (Hispanic), low and VL-income participants were less likely to utilize or receive CVD risk preventive services than their high-income counterparts (Tables S3a-S3d).”
Quote in the paperSubstantial claim - Findingown data
Low-income participants without CVD who visited a provider were less likely to have had their BP measured within the last 2 years than high-income participants (OR 0.65, 95% CI 0.56-0.75).
“Low- and VL-income participants were less likely to have had their BP measured within the last 2 years [OR 0.65 (0.56–0.75) and OR 0.65 (0.56–0.77), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants with CVD were not significantly less likely to receive dietary counseling than high-income participants (OR 0.95, 95% CI 0.86-1.04).
“Low-income (but not VL-income) participants were less likely to receive dietary counseling [OR 0.84 (0.76–0.93) and OR 0.95 (0.86–1.04)].”
Quote in the paperNot a substantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD were less likely to have had their BP measured within the last 2 years than high-income participants (OR 0.41, 95% CI 0.37-0.45).
“Low- and VL-income participants were less likely to have had their BP measured within the last 2 years [OR 0.45 (0.42–0.49) and OR 0.41 (0.37–0.45), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Even among middle- and high-income participants, in the unadjusted data, only 25-45% reported receiving CVD risk preventive services such as smoking cessation counseling or having their blood pressure checked.
“Additionally, we noted as well that even among middle and high income participants, when examining the unadjusted data, only 25–45% of people reported receiving CVD risk preventive services such as smoking cessation counseling or having their BP checked.”
Quote in the paperNot a substantial claim - Findingown data
Low-income participants without CVD who visited a provider and smoked were not significantly less likely to receive smoking cessation counseling than high-income participants (OR 0.85, 95% CI 0.73-1.00).
“Low- and VL-income participants who smoked trended less likely to receive smoking cessation counseling than their high-income counterparts, though results were not statistically significant [OR 0.85 (0.73–1.00) and OR 0.87 (0.75–1.01), respectively].”
Quote in the paperNot a substantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD who visited a provider were less likely to receive exercise counseling than high-income participants (OR 0.80, 95% CI 0.75-0.85).
“Low- and VL-income participants were less likely to receive exercise counseling [OR 0.82 (0.77–0.88) and OR 0.80 (0.75–0.85), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD were less likely to have had their cholesterol checked within the last 5 years than high-income participants (OR 0.36, 95% CI 0.33-0.38).
“Low- and VL-income participants were less likely to have had their cholesterol checked within the last 5 years [OR 0.42 (0.39–0.45) and OR 0.36 (0.33–0.38), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Among individuals with CVD who visited a provider within the past year, low- and VL-income participants were less likely to receive exercise counseling (OR 0.70 [0.62-0.79] and OR 0.67 [0.60-0.74]).
“Low- and VL-income participants were less likely to receive exercise counseling [OR 0.70 (0.62–0.79) and OR 0.67 (0.60–0.74), respectively].”
Quote in the paperSubstantial claim - Findingown data
VL-income participants with CVD who smoked were less likely to be advised to quit smoking than high-income participants (OR 0.78, 95% CI 0.61-0.99).
“Low- and VL-income participants who smoked were less likely to be advised to quit smoking than high-income participants [OR 0.64 (0.48–0.86) and OR 0.78 (0.61–0.99), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants with CVD were less likely to have had their cholesterol checked within the last 5 years than high-income participants (OR 0.33, 95% CI 0.26-0.42).
“Low- and VL-income participants were less likely to have had their cholesterol checked within the last 5 years [OR 0.34 (0.28–0.42) and OR 0.33 (0.26–0.42), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD who visited a provider were less likely to receive dietary counseling than high-income participants (OR 0.87, 95% CI 0.82-0.93).
“Low- and VL-income participants were less likely to receive dietary counseling [OR 0.90 (0.85–0.96) and OR 0.87 (0.82–0.93), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD were less likely to receive exercise counseling than high-income participants (OR 0.81, 95% CI 0.77-0.85).
“Low- and VL-income participants were less likely to receive exercise counseling [OR 0.79 (0.75–0.84) and OR 0.81 (0.77–0.85), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants without CVD who visited a provider were less likely to receive dietary counseling than high-income participants (OR 0.90, 95% CI 0.85-0.96).
“Low- and VL-income participants were less likely to receive dietary counseling [OR 0.90 (0.85–0.96) and OR 0.87 (0.82–0.93), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
In additional analyses stratified by sex, race and ethnicity, results were similar to the primary analyses.
“In the additional analyses stratified by sex, race and ethnicity, results were similar to the primary analyses.”
Quote in the paperNot a substantial claim - Findingown data
Low- and VL-income participants, both with and without CVD, were 20-70% less likely to receive CVD preventive services after adjusting for sociodemographic characteristics.
“The magnitude of the difference in the utilization of CVD preventive services between high- and low-income participants was particularly striking; low- and VL-income participants, both with and without CVD, were 20–70% less likely to receive these services after adjusting for sociodemographic characteristics.”
Quote in the paperSubstantial claim - Findingown data
Even after adjusting for baseline demographics, other socioeconomic factors and comorbidities, low-income U.S. adults were less likely to be screened for CVD risk factors (hypertension, hyperlipidemia) or receive counseling for CVD prevention (smoking cessation, exercise counseling, dietary counseling) than high-income adults, regardless of CVD status.
“Even after adjusting for baseline demographics, other socioeconomic factors and comorbidities, low-income U.S. adults were less likely to be screened for CVD risk factors (i.e. hypertension, hyperlipidemia) or receive counseling for prevention of CVD (i.e. smoking cessation, exercise counseling, dietary counseling) than high-income adults, regardless of CVD status.”
- Also stated in: § Conclusions · plain
“In this large, representative cross-sectional study of U.S. adults, we found that low- and VL-income adults were less likely to be screened for CVD risk factors or receive counseling to prevent CVD than high-income adults, regardless of CVD status.”
Quote in the paperSubstantial claim - Also stated in: § Conclusions · plain
- Findingown data
Low-income participants with CVD were less likely to have had their cholesterol checked within the last 5 years than high-income participants (OR 0.34, 95% CI 0.28-0.42).
“Low- and VL-income participants were less likely to have had their cholesterol checked within the last 5 years [OR 0.34 (0.28–0.42) and OR 0.33 (0.26–0.42), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants without CVD who visited a provider were less likely to have had their cholesterol checked within the last 5 years than high-income participants (OR 0.57, 95% CI 0.52-0.62).
“Low- and VL-income participants were less likely to have had their cholesterol checked within the last 5 years [OR 0.57 (0.52–0.62) and OR 0.55 (0.50–0.61), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants without CVD who visited a provider were less likely to receive exercise counseling than high-income participants (OR 0.82, 95% CI 0.77-0.88).
“Low- and VL-income participants were less likely to receive exercise counseling [OR 0.82 (0.77–0.88) and OR 0.80 (0.75–0.85), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants without CVD were less likely to have had their BP measured within the last 2 years than high-income participants (OR 0.45, 95% CI 0.42-0.49).
“Low- and VL-income participants were less likely to have had their BP measured within the last 2 years [OR 0.45 (0.42–0.49) and OR 0.41 (0.37–0.45), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants with CVD were less likely to receive dietary counseling than high-income participants (OR 0.84, 95% CI 0.76-0.93).
“Low-income (but not VL-income) participants were less likely to receive dietary counseling [OR 0.84 (0.76–0.93) and OR 0.95 (0.86–1.04)].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD who visited a provider were less likely to have had their cholesterol checked within the last 5 years than high-income participants (OR 0.55, 95% CI 0.50-0.61).
“Low- and VL-income participants were less likely to have had their cholesterol checked within the last 5 years [OR 0.57 (0.52–0.62) and OR 0.55 (0.50–0.61), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD who visited a provider were less likely to have had their BP measured within the last 2 years than high-income participants (OR 0.65, 95% CI 0.56-0.77).
“Low- and VL-income participants were less likely to have had their BP measured within the last 2 years [OR 0.65 (0.56–0.75) and OR 0.65 (0.56–0.77), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants with CVD who smoked were less likely to be advised to quit smoking than high-income participants (OR 0.64, 95% CI 0.48-0.86).
“Low- and VL-income participants who smoked were less likely to be advised to quit smoking than high-income participants [OR 0.64 (0.48–0.86) and OR 0.78 (0.61–0.99), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Low-income participants without CVD were less likely to receive exercise counseling than high-income participants (OR 0.79, 95% CI 0.75-0.84).
“Low- and VL-income participants were less likely to receive exercise counseling [OR 0.79 (0.75–0.84) and OR 0.81 (0.77–0.85), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
Both male and female low- and VL-income participants were generally less likely to utilize or receive CVD risk preventive services than high-income participants of the same sex.
“Both male and female low and VL-income participants were generally less likely to utilize or receive CVD risk preventive services, compared to high-income participants of the same sex (Tables S2a-S2b).”
Quote in the paperSubstantial claim - Findingown data
VL-income participants with CVD were less likely to receive exercise counseling than high-income participants (OR 0.84, 95% CI 0.76-0.93).
“Low- and VL-income participants were less likely to receive exercise counseling [OR 0.79 (0.71–0.87) and OR 0.84 (0.76–0.93), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD who smoked were less likely to be advised to quit smoking than high-income participants (OR 0.71, 95% CI 0.63-0.79).
“Low- and VL-income participants who smoked were less likely to be advised to quit smoking than high-income participants [OR 0.70 (95% CI, 0.62–0.79) and OR 0.71 (0.63–0.79), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income and low-income participants were more likely to live in the South, regardless of CVD status.
“Moreover, it was notable that VL-income and low-income participants were more likely to live in the South, regardless of participants’ CVD status.”
Quote in the paperNot a substantial claim - Findingown data
VL-income participants with CVD were less likely to have had their BP measured within the last 2 years than high-income participants (OR 0.32, 95% CI 0.22-0.46).
“Low- and VL-income participants were less likely to have had their BP measured within the last 2 years [OR 0.34 (0.24–0.49) and OR 0.32 (0.22–0.46), respectively].”
Quote in the paperSubstantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Findingown data
VL-income participants without CVD who visited a provider and smoked were not significantly less likely to receive smoking cessation counseling than high-income participants (OR 0.87, 95% CI 0.75-1.01).
“Low- and VL-income participants who smoked trended less likely to receive smoking cessation counseling than their high-income counterparts, though results were not statistically significant [OR 0.85 (0.73–1.00) and OR 0.87 (0.75–1.01), respectively].”
Quote in the paperNot a substantial claim- Rests on an assumption: Household income is a valid proxy for socioeconomic status.
- Rests on an assumption: Self-reported utilization of preventive services in MEPS is accurate.
- Rests on an assumption: The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
- Rests on an assumption: The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
- Premisecitation
Lower SES has been associated with increased prevalence of risk factors, such as hypertension, hyperlipidemia, obesity, smoking and physical activity.
“Additionally, lower SES has been associated with increased prevalence of risk factors, such as hypertension, hyperlipidemia, obesity, smoking and physical activity [8], [9], [10], [11], [12].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [8] Kanjilal, 2006, Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971-2002, Arch Intern Med source
- cites [9] Colhoun, 1998, Socio-economic status and blood pressure: an overview analysis, J Hum Hypertens source
- cites [10] Pigeyre, 2016, How obesity relates to socio-economic status: identification of eating behavior mediators, Int J Obes source
- Study design and conductreasoning
Due to the observational design, causality between income and utilization of CVD risk preventive services cannot be established.
“Third, due to the observational design, we cannot establish causality between income and utilization of CVD risk preventive services.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The observed disparities place socioeconomically disadvantaged populations at greater risk of having uncontrolled CVD risk factors and subsequently developing new or worsening CVD.
“This places socioeconomically disadvantaged populations at greater risk of having uncontrolled CVD risk factors and subsequently developing new or worsening CVD.”
Quote in the paperSubstantial claim- Rests on an assumption: Lower utilization of CVD preventive services causally leads to worse cardiovascular outcomes (uncontrolled risk factors and incident or worsening CVD).
- Classified as probably not a substantial claim. 16
- May combine two claims. 14
Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).
PremisecitationThe modified Charlson Comorbidity Index is a valid measure of comorbidity.
“modified Charlson Comorbidity Index [19,20]”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [19] Charlson, 1987, A new method of classifying prognostic comorbidity in longitudinal studies: development and validation, J Chronic Dis source
- cites [20] de Groot, 2003, How to measure comorbidity. a critical review of available methods, J Clin Epidemiol source
The Results report evidence for the Charlson Index’s validity and describe several adaptations; the Discussion concludes that the Charlson Index is a valid measure of comorbidity. Our copy does not identify which modification the citing document used or separately establish that version’s validity. (LLM, conf=0.83)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationReducing cardiovascular risk may reduce healthcare expenditures, which may unburden both patients and the U.S. health care system at large.
“Moreover, reducing cardiovascular risk may reduce healthcare expenditures, which may unburden both patients and the U.S. health care system at large [49], [50], [51].”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [49] Cawley, 2015, Savings in medical expenditures associated with reductions in body mass index among US Adults with Obesity, by Diabetes Status, Pharmacoeconomics source
The Background identifies obesity as a cardiovascular-disease risk factor, and the Conclusions estimate medical-expenditure savings from BMI reductions for individuals and society. The paper does not establish that reducing cardiovascular risk itself produces those savings or that patients’ own healthcare expenses fall. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [50] Valero-Elizondo, 2016, Favorable cardiovascular risk profile is associated with lower healthcare costs and resource utilization: the 2012 medical expenditure panel survey, Circ Cardiovasc Qual Outcomes source
- cites [51] Feldman, 2017, Favorable cardiovascular risk factor profile is associated with lower healthcare expenditure and resource utilization among adults with diabetes mellitus free of established cardiovascular disease: 2012 Medical Expenditure Panel Survey (MEPS), Atherosclerosis source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationDisparities between socioeconomic classes have worsened in recent decades.
“These disparities between socioeconomic classes have only worsened in recent decades [8,24].”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [8] Kanjilal, 2006, Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971-2002, Arch Intern Med source
- cites [24] Odutayo, 2017, Income disparities in absolute cardiovascular risk and cardiovascular risk factors in the United States, 1999-2014, JAMA Cardiol source
The discussion reports a growing income disparity in control of cardiovascular risk factors from 1999 to 2014: predicted cardiovascular risk, systolic blood pressure, and smoking improved in the highest-income group but not in the group at or below poverty level. It also says the income gap did not change for diabetes or cholesterol. The source therefore supports worsening disparities for specific cardiovascular measures, not an unqualified worsening of disparities between socioeconomic classes generally. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationAdditional studies found that socioeconomically deprived individuals were less likely to receive CVD preventive screening, but these studies were performed outside the U.S. and did not stratify individuals by existing CVD status.
“Additional studies examining preventive screening for CVD have found that socioeconomically deprived individuals were less likely to receive CVD preventive screening, but these studies were performed in countries outside of the U.S. and also did not stratify individuals based on existing CVD status [29], [30], [31].”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [29] Lang, 2016, Impact of socioeconomic deprivation on screening for cardiovascular disease risk in a primary prevention population: a cross-sectional study, BMJ Open source
- cites [30] Pappa, 2009, Factors affecting use of preventive tests for cardiovascular risk among Greeks, Int J Environ Res Public Health source
- cites [31] Rodin, 2012, Educational inequalities in blood pressure and cholesterol screening in nine European countries, J Epidemiol Community Health source
May combine two claims.
PremisecitationOne prior study using MEPS data found disparities in blood pressure and cholesterol checkups based on age, sex, insurance status, income status and race, but did not assess other CVD risk preventive services such as smoking cessation, dietary or exercise counseling, and did not stratify participants by CVD status.
“One prior study using data from MEPS found disparities in BP and cholesterol checkups based on age, sex, insurance status, income status and race, but did not assess for other CVD risk preventive services, such as smoking cessation, dietary or exercise counseling, and did not stratify participants based on CVD status [26].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [26] Vaidya, 2011, Utilization of preventive care services and their effect on cardiovascular outcomes in the United States, Risk Manag Healthc Policy source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationIndividuals of lower socioeconomic status experience worse cardiovascular outcomes and have higher rates of cardiovascular risk factors.
“Studies have shown that individuals of lower SES experience worse cardiovascular outcomes and have higher rates of cardiovascular risk factors [5,[21], [22], [23]].”
Quote in the paperNot a substantial claim3 of 3 sources checked- cites [5] Schrage, 2021, Lower socioeconomic status predicts higher mortality and morbidity in patients with heart failure, Heart source
The Introduction states that lower SES is associated with poorer outcomes in the general population and in patients with cardiovascular disease. The Morbidity/mortality section reports more cardiovascular events at lower SES, and the Prevalence of socioeconomic risk factors section links lower SES with smoking, obesity and diabetes. Those risk-factor findings come from patients with heart failure, so they do not establish higher rates among individuals generally. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [21] Schultz, 2018, Socioeconomic status and cardiovascular outcomes: challenges and interventions, Circulation source
- cites [22] Topel, 2019, Neighborhood socioeconomic status and adverse outcomes in patients with cardiovascular disease, Am J Cardiol source
The Results report more cardiovascular risk factors and worse outcomes among people living in lower-SES neighborhoods. The cited study measures neighborhood SES in a cohort with cardiovascular disease, not individuals’ own SES or the general population, so the unqualified claim is broader than its findings. (LLM, conf=0.85)
Experimental — accuracy not yet measured
May combine two claims.
Findingnone givenLow-income participants in MEPS were more likely to be Black or Hispanic adults, uninsured, and have a lower educational attainment level.
“Fourth, low-income participants in MEPS were more likely to be Black or Hispanic adults, uninsured and have a lower educational attainment level.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataIn the subgroup analysis restricted to individuals with CVD who visited their healthcare provider at least once within the 12 months prior to the survey, results were similar to the primary analyses, though some were no longer statistically significant.
“In the subgroup analysis restricted to individuals with CVD who visited their healthcare provider at least once within the 12 months prior to the survey, results were similar, though some were no longer statistically significant (Table 3b).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAmong individuals with CVD who visited a provider within the past year, low- and VL-income participants trended less likely to receive dietary counseling, but the results were not statistically significant (OR 0.88 [0.77-1.00] and OR 0.93 [0.82-1.06]).
“Low- and VL-income participants trended less likely to receive dietary counseling but the results were not statistically significant [OR 0.88 (0.77–1.00) and OR 0.93 (0.82–1.06)].”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe observed disparities persisted in subgroup analyses of individuals who had visited their healthcare provider at least once within the prior 12 months, as well as in secondary analyses stratified by sex, race and ethnicity.
“Notably, these disparities persisted in subgroup analyses of individuals who had visited their healthcare provider at least once within the prior 12 months, as well as in secondary analyses stratified by sex, race and ethnicity.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationWhile lower SES has been associated with lower utilization of some preventive care services, the relationship between SES and utilization of preventive services with a focus on CVD prevention is less well understood, especially in a representative sample of the U.S. population.
“However, while lower SES has been associated with lower utilization of some preventive care services, the relationship between SES and utilization of preventive services with a focus on CVD prevention is less well understood, especially in a representative sample of the United States (U.S.) population [13].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Sambamoorthi, 2003, Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women, Prev Med source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataSubgroup analyses stratified by sex, race, and ethnicity were not adjusted for additional variables.
“models for these subgroup analyses were not adjusted for additional variables.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataThe study adjusted for age, race/ethnicity, sex, region, health insurance, educational status and Charlson Comorbidity Index in its models.
“We adjusted for age, race/ethnicity, sex, region, health insurance, educational status and Charlson Comorbidity Index in our models.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationMEPS data include information about demographic and socioeconomic characteristics, patients' experiences, medical comorbidities, prescription medications, utilization of healthcare resources, healthcare costs and payment sources.
“Results are reported annually and include information about demographic and socioeconomic characteristics, patients' experiences, medical comorbidities, prescription medications, utilization of healthcare resources, healthcare costs and payment sources.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [14] "Medical Expenditure Panel Survey." Accessed May 29, 2021 http://meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [15] Cohen, 1996, The Medical Expenditure Panel Survey: a national health information resource, Inquiry
Classified as probably not a substantial claim.
Study design and conductreasoningTo account for possible variation in participant adherence to visits with primary healthcare providers, the study conducted subgroup analyses of participants with and without CVD, restricted to only those who had visited their healthcare provider at least once within the 12 months prior to the survey.
“To account for possible variation in participant adherence to visits with primary healthcare providers, we conducted subgroup analyses of participants with and without CVD, restricted to only those who had visited their healthcare provider at least once within the 12 months prior to the survey.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataAnalyses were conducted using Stata, version 14, incorporating variance estimation and person-level weights to maintain the nationally representative study sample.
“Analyses were conducted using Stata, version 14 (StataCorp, College Station, TX), incorporating variance estimation and person-level weights to maintain the nationally representative study sample.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningBecause MEPS relies on participant self-report, there may be recall bias, with participants potentially underestimating their CVD history or misreporting their use of services.
“First, since MEPS relies on participant self-report, there may be some recall bias: participants may not accurately recall their experiences and may underestimate their CVD history or misreport their use of services.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationInsured participants from the 1996 MEPS survey who had a usual source of care were over four times as likely to have their blood pressure or cholesterol checked compared to those who were uninsured and had no usual source of care.
“Insured participants from the 1996 MEPS survey who had a usual source of care were over four times as likely to have their BP or cholesterol checked compared to those who were uninsured and had no usual source of care [28].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] DeVoe, 2003, Receipt of preventive care among adults: insurance status and usual source of care, Am J Public Health source
Probably not a substantial claim: may not pass S4 (based).
Premisenone givenPotential differences in utilization of specifically CVD risk preventive services among representative socioeconomic populations in the U.S., examining both individuals with and without CVD, are less well understood.
“However, potential differences regarding utilization of specifically CVD risk preventive services among representative socioeconomic populations in the U.S., examining both individuals with and without CVD, are less well understood.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationcitationIncome status alone cannot account for all forms of socioeconomic disparity and, in particular, may not account for structural discrimination and racism.
“We acknowledge that income status alone cannot account for all forms of socioeconomic disparity, and in particular, may not account for structural discrimination and racism that is still prevalent in our society [43].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [43] Churchwell, 2020, Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the american heart association, Circulation source
May combine two claims.
Study design and conductown dataThe analyses adjusted for region to account for geographic differences, though residual confounding from lack of more granular geographic information may remain.
“We attempted to account for this by adjusting for region in our analyses, but acknowledge that there may be residual confounding that we cannot adjust for due to lack of more granular geographical information about MEPS participants.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIndividuals of lower socioeconomic status have been shown to be less likely to utilize or receive preventive care services such as cancer screening, vaccinations, eye examinations and dental examinations.
“Individuals of lower SES have also been shown to be less likely to utilize or receive preventive care services such as cancer screening, vaccinations, eye examinations and dental examinations [13,25].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [13] Sambamoorthi, 2003, Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women, Prev Med source
- cites [25] Patel, 2007, Socio-economic position and the use of preventive health care in older British women: a cross-sectional study using data from the British Women's Heart and Health Study cohort, Fam Pract source
Classified as probably not a substantial claim.
Study design and conductreasoningA subgroup analysis of only those who had seen a healthcare provider within the last 12 months was performed to account for variation in visit regularity.
“We attempted to account for this by performing a subgroup analysis of only those who had seen a healthcare provider within the last 12 months.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataIndividual income status may be independently associated with a lower likelihood of utilizing CVD preventive services, though it is heavily intertwined with other social determinants of health such as race/ethnicity, education level and insurance status.
“Our findings also suggest that though it is often heavily intertwined with other social determinants of health such as race/ethnicity, education level and insurance status, individual income status may be independently associated with a lower likelihood of utilizing CVD preventive services.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThe analyses adjusted for age, and in subgroup analyses restricting to participants who had seen a provider within the past year, disparities still persisted.
“However, we adjusted for age in our analyses and in subgroup analyses restricting to only participants who had seen a provider within the past year, disparities still persisted.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThere may be residual confounding due to other unmeasured social determinants of health or clinical comorbidities.
“There may be residual confounding due to other unmeasured social determinants of health or clinical comorbidities.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOther studies have shown disparity in utilization of U.S. Preventive Services Task Force-supported preventive care services such as blood pressure and cholesterol screening based on insurance status, though not necessarily based on income.
“Other studies have shown the disparity in utilization of preventive care services supported by the U.S. Preventive Services Task Force such as BP and cholesterol screening based on insurance status, though not necessarily based on income [27,28].”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe association between socioeconomic disparity and cardiovascular outcomes is well established.
“The association between socioeconomic disparity and cardiovascular outcomes is well established.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Modifiable CVD risk factors are associated with worse cardiovascular outcomes such as myocardial infarction, stroke, heart failure and death.
“Modifiable CVD risk factors are associated with worse cardiovascular outcomes such as myocardial infarction, stroke, heart failure and death.”
The paper relies on this without support.
Whether the relationship between SES and utilization of CVD preventive services varies by preexisting CVD status is unknown.
“Furthermore, whether this relationship varies depending on an individual's preexisting CVD status is also unknown.”
The paper relies on this without support.
Household income is a valid proxy for socioeconomic status.
“Using data from a nationally representative U.S. sample and household income as a proxy for SES”
The paper relies on this without support.
Self-reported utilization of preventive services in MEPS is accurate.
“These outcomes were ascertained from the MEPS survey completed annually by the participants.”
The paper relies on this without support.
The preventive care services measured (smoking cessation counseling, BP measurement, exercise counseling, dietary counseling, lipid panel testing) are valid indicators of CVD preventive care.
“The primary outcomes were utilization of the following CVD risk preventive care services: smoking cessation counseling (”
The paper relies on this without support.
The ICD-9-CM codes used to identify CVD accurately identify individuals with CVD.
“Individuals with CVD were identified by self-report or International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for the diagnoses of coronary artery disease (ICD-9: 410, 413, and 414), stroke (ICD-9: 433–437), heart failure (ICD-9: 428), cardiac dysrhythmia (ICD-9: 427) or peripheral artery disease (ICD-9: 440, 443, 447).”
The paper relies on this without support.
Lower utilization of CVD preventive services causally leads to worse cardiovascular outcomes (uncontrolled risk factors and incident or worsening CVD).
“This places socioeconomically disadvantaged populations at greater risk of having uncontrolled CVD risk factors and subsequently developing new or worsening CVD.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Age category differs between Methods and tables
MinorThe Methods define an age category beginning at 67, while Table 1a uses a category beginning at 65.
“age (18–39, 40–64, 67–74 or 75+ years old)”
“| 65–74 | 8.9 | 6.9 | 8.3 | 5.9 | <0.001 |”
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BackgroundSocioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions
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“Individuals of lower SES have orse cardiovascular outcomes, such as CVD-related mortality [7] .”
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Food store availability and neighborhood characteristics in the United States
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BackgroundSocio-economic status and blood pressure: an overview analysis
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Receipt of preventive care among adults: insurance status and usual source of care
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“We classified income into 4 distinct subgroups: [1] highncome if household income was greater than 400% of the federal overty level (FPL), [2] middle-income if household income was beween 200 and 400% of the FPL, [3] low-income if household income”
BackgroundRandomised trials of secondary prevention programmes in coronary heart disease: systematic review
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Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women
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Impact of multiple social determinants of health on incident stroke
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The Epidemiology of Overweight and Related Lifestyle Behaviors
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BackgroundSelf-citationAssociation of Income Disparities with Patient-Reported Healthcare Experience
Okunrintemi, V., Khera, R., Spatz, E. S., Salami, J., Elizondo, J. V., Warraich, H. J., Virani, S. S., Blankstein, R., Blaha, M. J., Pawlik, T. M., et al. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-04848-4 · Cited by 92 · see citing works
Self-citationHow obesity relates to socio-economic status: identification of eating behavior mediators
Pigeyre, M., Rousseaux, J., Trouiller, P., Dumont, J., Goumidi, L., Bonte, D., Dumont, M.-P., Chmielewski, A., Duhamel, A., Amouyel, P., et al. (2016) · International Journal of Obesity · doi:10.1038/ijo.2016.109 · Cited by 67 · see citing works
Socioeconomic differences in nicotine exposure and dependence in adult daily smokers
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Neighbourhood socioeconomic status and coronary heart disease in individuals between 40 and 50 years
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BackgroundLower socioeconomic status predicts higher mortality and morbidity in patients with heart failure
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BackgroundNeighborhood socioeconomic status and adverse outcomes in patients with cardiovascular disease
Topel, M. L., Kim, J. H., Mujahid, M. S., Sullivan, S. M., Ko, Y.-A., Vaccarino, V., Quyyumi, A. A., & Lewis, T. T. (2019) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.10.011 · Cited by 47 · see citing works
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Positive social interaction offsets impact of low socioeconomic status on stress
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Trust in Health Care Providers: Factors Predicting Trust among Homeless Veterans over Time
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Educational inequalities in blood pressure and cholesterol screening in nine European countries
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Factors affecting use of preventive tests for cardiovascular risk among Greeks
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A Heart-Healthy Diet for Cardiovascular Disease Prevention: Where Are We Now?
Diab, A., Dastmalchi, L. N., Gulati, M., & Michos, E. D. (2023) · Vascular Health and Risk Management · doi:10.2147/vhrm.s379874 · Cited by 202 · see citing works
“Additionally, individuals of lower income have been shown to be less likely counseled on diet modifications for CVD prevention in a representative US sample.(153) “Food deserts” (or grocery areas that lack fresh produce), “food swamps” (with excess of ultra-processed poor quality foods), and food insecurity all are co…”
BackgroundSelf-citationDhingra, L. S., Aminorroaya, A., Oikonomou, E. K., Nargesi, A. A., Wilson, F. P., Krumholz, H. M., & Khera, R. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.16634 · Cited by 158 · see citing works
Family income and cardiovascular disease risk in American adults
Minhas, A. M. K., Jain, V., Li, M., Ariss, R. W., Fudim, M., Michos, E. D., Virani, S. S., Sperling, L. S., & Mehta, A. (2023) · Scientific Reports · doi:10.1038/s41598-023-27474-x · Cited by 109 · see citing works
Self-citationZahid, S., Din, M. T. U., Minhas, A., Rai, D., Kaur, G., Carfagnini, C. L., Khan, M. Z., Ullah, W., Spall, H. G. C. V., Hays, A. G., et al. (2022) · JACC Advances · doi:10.1016/j.jacadv.2022.100062 · Cited by 32 · see citing works
Self-citationZahid, S., Khan, M. Z., Gowda, S. N., Faza, N. N., Honigberg, M. C., Vaught, A. “. J., Guan, C. S., Minhas, A., & Michos, E. D. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.121.025839 · Cited by 28 · see citing works
“42,43 There are significant racial disparities in reduced access to menstrual counseling and obstetrics/gynecologic services, which is a driver of adverse events among Black women.”
Self-citationAhmed, W., Muhammad, T., Maurya, C., & Akhtar, S. N. (2023) · PLoS ONE · doi:10.1371/journal.pone.0287455 · Cited by 27 · see citing works
“Studies have found that lower individual-level SES are linked to a greater incidence and prevalence of CVD, such as coronary heart disease, heart failure, and stroke [52,57,58].”
BackgroundZahid, S., Mohamed, M. S., Wassif, H. S., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.43388 · Cited by 26 · see citing works
Self-citationMani, S. S., & Schut, R. A. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.116003 · Cited by 20 · see citing works
Birth Cohort‒Specific Smoking Patterns by Family Income in the U.S.
Jeon, J., Cao, P., Fleischer, N. L., Levy, D. T., Holford, T. R., Meza, R., & Tam, J. (2023) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2022.07.019 · Cited by 19 · see citing works
Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe
Ares-Blanco, S., López-Rodríguez, J. A., Polentinos-Castro, E., et al. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02400-w · Cited by 17 · see citing works
“Particularly, addressing inequalities is not a straightforward task; factors such as poverty, housing insecurity, limited social support, and residing in neigh-bourhoods lacking adequate services can pose significant barriers to accessing the healthcare system [51].”
BackgroundResultUse Of High- And Low-Value Health Care Among US Adults, By Income, 2010–19
Park, S., & Wadhera, R. K. (2024) · Health Affairs · doi:10.1377/hlthaff.2023.00661 · Cited by 13 · see citing works
Yogeswaran, V., Kim, Y., Franco, R. L., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0300154 · Cited by 12 · see citing works
“Uninsured adults are less likely to receive treatment for chronic conditions, are more likely to have limited access to care, and are more likely to have decreased utilization of recommended healthcare services [34, 38–40], which may be the result of income disparities [41].”
BackgroundZahid, S., Hashem, A. M., Minhas, A., Bennett, W. L., Honigberg, M. C., Lewey, J., Davis, M. B., & Michos, E. D. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.122.026786 · Cited by 12 · see citing works
Self-citationHealth Care Affordability Problems by Income Level and Subsidy Eligibility in Medicare
Park, S., & Fung, V. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.32862 · Cited by 11 · see citing works
Abdalla, S. M., Rosenberg, S. B., Maani, N., Contreras, C. M., Yu, S., & Galea, S. (2025) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2025.101039 · Cited by 13 · see citing works
“43,44 The weaker association for more acute outcomes such as heart attack can be due to higher mortality rates among lower income populations, which in turn can lead to reporting only by the surviving population.”
Osibogun, O. I., Ogunmoroti, O., Turkson‐Ocran, R., Okunrintemi, V., Kershaw, K. N., Allen, N. B., & Michos, E. D. (2024) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2024.100640 · Cited by 7 · see citing works
“Moreover, low socioeconomic status is a known risk factor for poorer health outcomes, which is partly due to unhealthy lifestyles [36 – 38] but also associated with reduced access to healthcare and preventive services [39].”
BackgroundSelf-citationLee, B., Rosen, L. V., Mulroy, N. M., Qian, Y., Shebl, F. M., Becker, J. E., Hyle, E. P., Levy, D. E., & Reddy, K. P. (2024) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2024.10.008 · Cited by 5 · see citing works
Nuñez, S. D., Spratt, L. M., Ware, C. F., Machado, S., Rousseau, J., Jackson, T. L., Buckley, J., Magee, S. R., Wohler, D., Blosser, E., et al. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.108114 · Cited by 4 · see citing works
The Association of Persistent Poverty and Outcomes Among Patients Undergoing Cardiac Surgery
Azap, L. E., Woldesenbet, S., Lima, H., Munir, M. M., Díaz, A., Endo, Y., Yang, J., Mokadam, N. A., Ganapathi, A. M., & Pawlik, T. M. (2023) · Journal of Surgical Research · doi:10.1016/j.jss.2023.07.030 · Cited by 4 · see citing works
Income-Based Inequalities in Health System Performance in the US and South Korea
Park, S., Eggleston, K. N., Kyung, Y., et al. (2026) · JAMA Health Forum · doi:10.1001/jamahealthforum.2026.0136 · Cited by 3 · see citing works
Maraey, A. M., Yazdi, V., Chaaban, N., Aglan, A. D., Elzanaty, A., Moustafa, A., Karim, S., & He, B. J. (2024) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.15043 · Cited by 3 · see citing works
“28 The recovery period and restrictions post-operatively further add to the economic burden forthesepatients.”
Living in poverty is associated with gene expression changes in immune cells
Arnold, N. S., Resztak, J., Witonsky, D., Alazizi, A., Hooten, N. N., Evans, M. K., Odero‐Marah, V., Dluzen, D. F., Piqué-Regi, R., & Luca, F. (2025) · Genetics · doi:10.1093/genetics/iyaf072 · Cited by 3 · see citing works
Poghosyan, L., Liu, J., Spatz, E. S., Flandrick, K., Osakwe, Z. T., & Martsolf, G. R. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08367-1 · Cited by 3 · see citing works
Moudden, I. E., Asra, A., Reem, S. A., Bittner, M. L., & Zhang, Q. (2025) · BMC Cardiovascular Disorders · doi:10.1186/s12872-025-04771-z · Cited by 2 · see citing works
“This suggests that local demographic, socioeconomic, and health-care infrastructure factors significantly influence CVDs outcomes [59].”
Baek, S., Lee, Y., & Yoon, J. (2024) · Preventive Medicine · doi:10.1016/j.ypmed.2024.107849 · Cited by 2 · see citing works
Benjasirisan, C., Elias, S. D., Lim, A., et al. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.032919 · Cited by 2 · see citing works
Azap, L. E., Díaz, A., Gouchoe, D. A., Mokadam, N. A., Smith, S. A., Henn, M. C., Whitson, B. A., Habib, A., Lampert, B. C., Pawlik, T. M., et al. (2024) · JHLT Open · doi:10.1016/j.jhlto.2024.100079 · Cited by 2 · see citing works
“18 Patients with pre-existing diabetes commonly see their diabetes worsen due to chronic steroid usage and if not appropriately controlled this may lead to worsening diabetes and impact other outcomes.”
Okoli, G. N., Righolt, C. H., Zhang, G., et al. (2024) · Canadian Journal of Public Health · doi:10.17269/s41997-024-00893-7 · Cited by 1 · see citing works
“Moreover, previous studies have reported negative correlations between income and health care utilization among many populations (Econo-mou et al., 2008; Academies of Sciences, 2018; Shahu et al., 2021), including Canada’s (Curtis & MacMinn, 2008; Penning & Zheng, 2016).”
Brown, B., Adediran, E., Taylor, E., Ose, D. J., & Okuyemi, K. S. (2025) · American Journal of Lifestyle Medicine · doi:10.1177/15598276251370976 · Cited by 1 · see citing works
“21 In addition, low income, low educational attainment, living in a food desert, or living in a rural community are associated with an increased risk for poor diet quality.”
Jun, J., Frogner, B. K., Carle, A. C., et al. (2026) · Workplace Health & Safety · doi:10.1177/21650799251408100 · Cited by 1 · see citing works
“This contrasts with prior research showing that low-wage earners are less likely to receive counseling on diet, smoking cessation, or physical activity than higher-income adults (Shahu et al., 2021).”
Changes in Haematological Parameters and Lipid Profiles in Diabetes Mellitus: A Literature Review
Mbah, J. I., Bwititi, P., Gyawali, P., & Nwose, E. U. (2024) · Cureus · doi:10.7759/cureus.64201 · Cited by 1 · see citing works
Siriwardhana, C., Carrazana, E. J., & Liow, K. K. (2025) · Journal of Alzheimer s Disease · doi:10.1177/13872877251351216 · Cited by 1 · see citing works
Lekovic, T., Janićijević, N., Potezica, M., et al. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1569741 · Cited by 1 · see citing works
“A previous study has shown that lower socioeconomic status has been linked to reduced utilization of other preventive care services (24).”
Poverty shapes the transcriptome of immune cellsPreprint
Arnold, N. S., Resztak, J., Witonsky, D., Alazizi, A., Hooten, N. N., Evans, M. K., Odero‐Marah, V., Dluzen, D. F., Piqué-Regi, R., & Luca, F. (2022) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2022.12.06.517536
Umeh, K. F., & Adaji, S. (2024) · Research Square · doi:10.21203/rs.3.rs-4149807/v1
Cao, J., & Huang, L. (2024) · Highlights in Science Engineering and Technology · doi:10.54097/hxq6ar80
“And low-income populations are unlikely to undergo CVD risk factor screening or receive CVD prevention counseling [1].”
BackgroundZimmermann, K., Ford, C., Carnahan, L. R., et al. (2025) · Preventing Chronic Disease · doi:10.5888/pcd22.240412
Zhang, X., Wang, H., He, Y., Zhang, J., Jia, X., Huang, F., Ouyang, Y., Zhang, B., Xiao, X., Wang, Q., et al. (2025) · British Journal Of Nutrition · doi:10.1017/s0007114525105011
“Research in a representative US sample (46) has demonstrated that individuals with lower income levels are less likely to receive dietary counselling aimed at CVD prevention.”
Ares-Blanco, S., López-Rodríguez, J. A., Polentinos-Castro, E., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25834190
Awareness and Perceptions of Medicare Annual Wellness Visits Among Older Adults in Arkansas
Driver, N., Burgess, L., Bona, B., et al. (2026) · Health Promotion Practice · doi:10.1177/15248399251411326
“Social factors can also influence those perceptions, with women and those of higher socioeconomic status being more likely to accept preventive care (Shahu et al., 2021; Vaidya et al., 2012).”
Bergman, A., & Nathan, A. S. (2026) · Health Services Research · doi:10.1111/1475-6773.70117
“These patients face greater exposure to cardiovascular risk factors, reduced access to preventive care, and fewer opportunities for early disease, arriving for procedures with more advanced disease [40–42].”
Mbah, J. I., Bwititi, P., Gyawali, P., Ong, L. K., & Nwose, E. U. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15134995
“In the case of lipid measurements in diabetes management, it is important to acknowledge that there are limitations regarding the accessibility and affordability of the recommended lipid profile tests, especially in low-and middle-income countries [11,12].”
Cardiometabolic comorbidity burden and mortality in the United States and China
Zhang, Z., Tan, S., Xiao, Y., Tu, T., Lin, Q., Dai, Y., Zhu, J., Hu, K., Zeng, G., Li, K., et al. (2026) · iScience · doi:10.1016/j.isci.2026.116832
Neighborhood income and atherosclerotic burden on coronary CT angiography
Rokni, M., Piran, M., Naganawa, S., et al. (2026) · The American Journal of Medicine · doi:10.1016/j.amjmed.2026.08.031
- Authors
- Shahu, A., Okunrintemi, V., Tibuakuu, M., Khan, S. U., Gulati, M., Marvel, F., Blumenthal, R. S., & Michos, E. D.
- Affiliations
- Johns Hopkins University (US)
- Houston Methodist (US)
- University of Arizona College of Medicine- Phoenix (US)
- Corresponding author
- Shahu, Andi
- ORCID
- Venue
- American Journal of Preventive Cardiology
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 8
- Pages
- 100286
- ISSN
- 2666-6677 (ISSN-L)
- PMC
- PMC8593567
- OpenAlex
- W3214438341
- Semantic Scholar
- 5ca50b1ce1fa318a1daa8759a0f4fb142f0d033f
- Cited by
- 44
- References
- 55
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 14 · 2023: 8 · 2022: 5
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- American Journal of Preventive Cardiology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Johns Hopkins University
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- income inequality, cardiovascular disease, preventive medicine, health care utilization, low-income adults, blood pressure screening, cholesterol screening, lifestyle counseling, smoking cessation counseling, physical activity counseling, cardiovascular risk factors, racial and ethnic disparities, sex disparities, health care access, United States adults, Medical Expenditure Panel Survey, federal poverty level, health insurance status, health care costs, quality of care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
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