An American divide: Chronic disease rates

  | January 19, 2017

Last fall's election results revealed a sharply divided nation — in terms of politics, and in terms of health. Studies have shown that Trump voters tend to be less healthy than Clinton voters. And new data from the athenahealth network reveals some of the measures where the gap is broadest: chronic diseases, such as hypertension and diabetes, that benefit from consistent primary care.

The analysis looked at records for 6.2 million patients ages 23 to 64, treated in primary care settings in 2015 on athenahealth's network of 85,000 providers. The results are based on patients with commercial insurance — although, researchers note, the trends are consistent when Medicaid patients are included.

According to diagnosis codes, physicians in counties that voted for President-elect Trump by 40 percentage points or more see higher rates of patients with hypertension, high cholesterol, diabetes, and depression and anxiety.

The gap in health status between Trump and Clinton communities is particularly pronounced in hypertension: The rate of high blood pressure is 7 percentage points higher in those that supported Trump.

Hypertension is more prevalent overall among black Americans, so researchers also looked at rates for the disease among white patients only — and the gap widened. Hypertension is 11 percentage points more prevalent among white patients in Trump-supporting counties than among whites in Clinton counties.

Like hypertension, the other diseases tracked by athenahealth's researchers are chronic conditions that, when untreated, lead to stroke, heart attacks, and dementia — health crises that drive much of the high cost of healthcare in the United States.

These are the chronic conditions that, clinicians say, are best treated early and continuously in an established relationship with a primary care physician. They are also among the diseases that benefit most from insurance coverage for preventive treatment.

Writing in The New Yorker about the value of enduring relationships between patients and their primary care physicians, Atul Gawande, M.D., noted that “good treatment for hypertension is like bridge maintenance: it requires active monitoring and incremental fixes and adjustments over time but averts costly disasters."

As Trump looks to repeal and replace the Affordable Care Act, the state of insurance coverage — and of Medicaid expansion — is an open question. Will his new healthcare policies be effective when it comes to addressing chronic disease?

Gale Pryor is a senior writer for athenaInsight. Data analysis by Dorrie Raymond.

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What is this supposed to mean? Is Athena trying to make a statement? Should a private company engage in political advocacy?
Name: 
Daniel
Email: 
manskemd@gmail.com
I think it interesting that our so called representatives voted thmselves the best healthcare on the market yet think WE THE PEOPLE DO NOT DESERVE HEALTHCARE. NOR SOCIAL SECURITY. stole billions from veterans care yet want our young to get killed and maimed in wars. Now they want to kill us for protesting the swill they force on us. I have friends in their 70s still working because they cant afford their medications! Now we have billionaires running our country. We are doomed. I am a dead woman typing this. When they steal my healthcare, im dead quickly!!!
Name: 
Cynthia Hufford
Email: 
cynthiahufford@gmail.com
Could this research data also indicate that the younger generation voted for Hillary, and Trump got his votes from the older, more discerning generation, that also have the high blood pressure, diabetes, heart disease, etc. It sounds logical to me.
Name: 
Lavonne Lee
Email: 
Sparkleteeth@gmail.com
Good question. I would like to see a statistical analysis of this data to see if it accounts for such confounding variables.
Name: 
Daniel Manske
Email: 
manskemd@gmail.com
What about unwed pregnancy, abortion, drug abuse, alcohol abuse, tobacco abuse, marijuana use, and sexually transmitted diseases including HPV, hepatic C and AIDS? How come no mention of these data points?
Name: 
Robert D Peterson MD
Email: 
Rpeterson@suddenlinkmail.com
I noticed the data is taken from primary care settings. Does it hold true if emergent settings are factored in? Is there a higher likelihood chronic illness not treated routinely presents in the ER, and if so, is it enough to affect the results (more in urban than rural counties)? Regarding the impact of the Trump administration on population health, it would be interesting to see how these numbers have changed compared to pre-Obama care.
Name: 
Scott Ferguson
Email: 
scott10ferguson@gmail.com
This study was done while our country was led by the Liberals which was very difficult for us conservatives. I know my blood pressure etc has dropped dramatically since Trump was elected. Do another study while Trump is in office.
Name: 
Martha Wright
Email: 
Martyjw41@sbcglobal.net
Would you please stop trying to divide our country! I clicked on this to look at disease data and all I see is more stirring the pot with politics. Please give us something to read that will bring unity and concern for things such as disease.
Name: 
Linda Ward
Email: 
wardy20@hotmail.com

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An American divide: Chronic disease rates