TY - JOUR
T1 - When the economy falters, hearts suffer
T2 - Economic recessions as a social determinant of health in cardiovascular emergencies
AU - Won, Daniel
AU - Workman, Connor
AU - Walker, James
AU - Zordani, Elizabeth
AU - Bajaj, Pranav
AU - Chen, Zhanlin
AU - Asthana, Shravan
AU - Liu, Tom
AU - Christopher Malaisrie, S.
AU - McCarthy, Danielle M.
AU - Adams, James G.
AU - Lundberg, Alex
N1 - Publisher Copyright:
© 2023
PY - 2024/2
Y1 - 2024/2
N2 - Introduction: While the relationships between cardiovascular disease (CVD), stress, and financial strain are well studied, the association between recessionary periods and macroeconomic conditions on incidence of disease-specific CVD emergency department (ED) visits is not well established. Objectives: This retrospective observational study aimed to assess the relationship between macroeconomic trends and CVD ED visits. Methods: This study uses data from the National Hospital Ambulatory Care Survey (NHAMCS), Federal Reserve Economic Database (FRED), National Bureau of Economic Research (NBER), and CVD groupings from National Vital Statistics (NVS) and Center for Medicare and Medicaid Services (CMS) from 1999 to 2020 to analyze ED visits in relation to macroeconomic indicators and NBER defined recessions and expansions. Results: CVD ED visits grew by 79.7% from 1999 to 2020, significantly more than total ED visits (27.8%, p < 0.001). A national estimate of 213.2 million CVD ED visits, with 22.9 million visits in economic recessions were analyzed. A secondary group including a 6-month period before and after each recession (defined as a “broadened recession”) was also analyzed to account for potential leading and lagging effects of the recession, with a total of 50.0 million visits. A significantly higher proportion of CVD ED visits related to heart failure (HF) and other acute ischemic heart diseases (IHD) was observed during recessionary time periods both directly and with a 6-month lead and lag (p < 0.05). The proportion of aortic aneurysm and dissection (AAA) and atherosclerosis (ASVD) ED visits was significantly higher (p = 0.024) in the recession period with a 6-month lead and lag. When controlled for common demographic factors, economic approximations of recession such as the CPI, federal funds rate, and real disposable income were significantly associated with increased CVD ED visits. Conclusion: Macroeconomic trends have a significant relationship with the overall mix of CVD ED visits and represent an understudied social determinant of health.
AB - Introduction: While the relationships between cardiovascular disease (CVD), stress, and financial strain are well studied, the association between recessionary periods and macroeconomic conditions on incidence of disease-specific CVD emergency department (ED) visits is not well established. Objectives: This retrospective observational study aimed to assess the relationship between macroeconomic trends and CVD ED visits. Methods: This study uses data from the National Hospital Ambulatory Care Survey (NHAMCS), Federal Reserve Economic Database (FRED), National Bureau of Economic Research (NBER), and CVD groupings from National Vital Statistics (NVS) and Center for Medicare and Medicaid Services (CMS) from 1999 to 2020 to analyze ED visits in relation to macroeconomic indicators and NBER defined recessions and expansions. Results: CVD ED visits grew by 79.7% from 1999 to 2020, significantly more than total ED visits (27.8%, p < 0.001). A national estimate of 213.2 million CVD ED visits, with 22.9 million visits in economic recessions were analyzed. A secondary group including a 6-month period before and after each recession (defined as a “broadened recession”) was also analyzed to account for potential leading and lagging effects of the recession, with a total of 50.0 million visits. A significantly higher proportion of CVD ED visits related to heart failure (HF) and other acute ischemic heart diseases (IHD) was observed during recessionary time periods both directly and with a 6-month lead and lag (p < 0.05). The proportion of aortic aneurysm and dissection (AAA) and atherosclerosis (ASVD) ED visits was significantly higher (p = 0.024) in the recession period with a 6-month lead and lag. When controlled for common demographic factors, economic approximations of recession such as the CPI, federal funds rate, and real disposable income were significantly associated with increased CVD ED visits. Conclusion: Macroeconomic trends have a significant relationship with the overall mix of CVD ED visits and represent an understudied social determinant of health.
KW - CPI
KW - CVD
KW - Cardiovascular disease
KW - Economic recession
KW - Economics
KW - Economics of healthcare
KW - FRED
KW - Federal funds rate
KW - Ischemic heart disease
KW - NBER
KW - Overcrowding
KW - SDOH
KW - Social determinates of health
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U2 - 10.1016/j.ajem.2023.11.036
DO - 10.1016/j.ajem.2023.11.036
M3 - Article
C2 - 38086181
AN - SCOPUS:85179614688
SN - 0735-6757
VL - 76
SP - 155
EP - 163
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -