Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And
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Healthcare fragmentation and cardiovascular risk control among older cancer survivors in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study Laura C. Pinheiro 1
&
Evgeniya Reshetnyak 1 & Monika M. Safford 1 & David Nanus 2 & Lisa M. Kern 1
Received: 9 July 2020 / Accepted: 30 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Cardiovascular disease (CVD) is the number one cause of death among 5-year cancer survivors. Survivors see many providers and poor coordination may contribute to worse CVD risk factor control. We sought to determine associations between fragmentation and CVD risk factor control among survivors overall and by self-rated health. Methods We included REGARDS participants aged 66+ years who (1) had a cancer history; (2) reported diabetes, hypertension, or hyperlipidemia; and (3) had continuous Medicare coverage. Twelve-month ambulatory care fragmentation was calculated using the Bice-Boxerman Index (BBI). We determined associations between fragmentation and CVD risk factors, defining “control” as fasting glucose < 126 mg/dL or non-fasting glucose < 200 mg/dL for diabetes; blood pressure < 140/90 mmHg for hypertension; and total cholesterol 40 mg/dL for hyperlipidemia. Results The 1002 cancer survivors (2+ years since cancer treatment) had mean age of 75 years, 39% were women, and 23% were Black. Among individuals with diabetes (N = 225), hypertension (N = 660), and hyperlipidemia (N = 516), separately, approximately 60% had CVD risk factor control. Overall, more fragmented care was not associated with worse control. However, among cancer survivors with excellent, very good, or good health, more fragmentation was associated with a decreased likelihood of diabetes control (OR 0.78, 95% CI 0.61–0.99), adjusting for confounders. Conclusions More fragmented care was associated with worse glycemic control among cancer survivors with diabetes who reported excellent, very good, or good health. Associations were not observed for control of hypertension or hyperlipidemia. Implications for Cancer Survivors Reducing fragmentation may support glucose control among survivors with diabetes. Keywords Cancer survivors . CVD risk factor control . Care fragmentation . Diabetes . Self-rated health
Introduction The number of cancer survivors [1] is expected to grow by 25% over the next decade, with 20 million survivors anticipated by 2026 [2]. Cardiovascular disease (CVD) is the #1 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11764-020-00933-4) contains supplementary material, which is available to authorized users. * Laura C. Pinheiro [email protected] 1
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th Street, Box 331, New York, NY 10065, USA
2
Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
non-cancer cause of death among individuals who survive 5 or more years from their cancer di
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