Another big factor in some areas is actually inconsistent access to health care, which means little preventive care as well as counseling on risk factors for heart disease, said Salim Virani, director of the Cardiology Fellowship program at Houston’s Baylor College of Medicine. In Texas, which has high rates of heart disease although isn’t one of the states to see incidence rise since 2010, as many as 21 percent of the population lack health insurance according to some surveys, well above a national rate which fell as low as 10.9 percent after passage of the Affordable Care Act in 2010.
“The ‘why’ question can only partially be answered by what we currently know,” Roth said.
One reason for high percentages of people lacking health insurance is actually states’ refusal to expand Medicaid eligibility.
“If people lose health-care access, they wait before coming to see a doctor,’’ Virani said.
The study authors said relative disparities between states may be of particular concern for states, including Alabama as well as Oklahoma, given decisions not to expand their Medicaid systems under the ACA. as well as many of the red states which did expand Medicaid are still engaged in political battles over the ACA. In June a court overruled Kentucky’s plans to add a work requirement to its expanded Medicaid — This particular was the first state approved by the federal government to take advantage of a Trump administration decision to allow states to force low-income individuals to work as a qualification for Medicaid. Arkansas as well as Indiana were also approved by the government for the work requirement; Arizona, Kansas, Mississippi as well as Utah were among the states which had applications pending at the time of the court decision. All are among the heart disease laggards identified inside the study. There are concerns which the decision could lead different states to decide not to expand Medicaid at all.
Experts said the data point to the need to do more preventive care for heart disease risk factors. Florence points to programs which get providers out of hospitals as well as into the community, including in mobile settings like vans which offer screening as well as monitoring, as examples of what can be done. Others point to the need for a redoubling of efforts on smoking, as well as Virani said research is actually needed on whether smoking e-cigarettes will lead to teens switching to conventional tobacco.
Experts also want further study to get results on heart disease rates down to the county level, which will let them target resources better. Doctors also need to know more about the rise in obesity as well as diabetes which seem to be causing the slowed progress on health disease as well as to study best practices in counties as well as states which have kept up the improvement, said Seth Martin, director of the Advanced Lipid Disorders program at Baltimore’s Johns Hopkins Medicine.
“The frustrating thing is actually, we know how to prevent cardiovascular disease,’’ Roth said. “although we don’t always do these things, especially early in life.”