Addressing Cardiovascular Disease Disparities Among Medicare Beneficiaries: Insights from the Indian Health Service

Abstract

Background: Chronic illnesses, especially cardiovascular diseases (CVD), disproportionately affect populations served by the Indian Health Service (IHS), contributing to significantly higher morbidity and mortality rates. This study aimed to assess the prevalence and incidence of Coronary Artery Disease (CAD), Heart Failure (HF), Atrial Fibrillation (AF), and cerebrovascular diseases among Medicare beneficiaries (MBs) within these communities. Methods: Utilizing data from IHS electronic records spanning fiscal years 2021-2023, this study analyzed a cohort of 9,844 adults diagnosed with CVD. Demographic, health status, and healthcare utilization data were collected. Statistical analyses included multivariable logistic regression and propensity score matching to evaluate the relationship between healthcare utilization and cardiovascular outcomes. Results: The findings revealed that 49.9% of the participants experienced at least one severe cardiovascular condition, with CAD incidence slightly decreasing from 37.9% in 2021 to 38.2% in 2024 (P < .001). Conversely, the overall mortality rate was 20.1%, with CAD and HF being leading contributors. Socioeconomic factors significantly influenced healthcare access and outcomes, as 34.7% of the participants qualified for both Medicare and Medicaid. Conclusion: The study underscores the urgent need for targeted interventions to improve cardiovascular health outcomes in high-risk populations. Engaging with Indigenous communities and enhancing healthcare access through integrated care models are vital for addressing disparities and fostering better health equity. Future research should explore innovative strategies to optimize care delivery for these vulnerable populations.