BACKGROUND: Low-income working-age US adults disproportionately experienced health care disruptions at the onset of the coronavirus disease 2019 pandemic. Little is known about how health care access and cardiovascular risk factor management changed as the pandemic went on or if patterns differed by state Medicaid expansion status. METHODS: Cross-sectional data from the behavioral risk factor surveillance system were used to compare self-reported measures of health care access and cardiovascular risk factor management among US adults aged 18 to 64 years in 2021 (pandemic) to 2019 (prepandemic) using multivariable Poisson regression models. We assessed differential changes between low-income (<138% federal poverty level) and high-income (>400% federal poverty level) working-age adults by including an interaction term for income group and year. We then evaluated changes among low-income adults in Medicaid expansion versus nonexpansion states using a similar approach. RESULTS: The unweighted study population included 80 767 low-income and 184 136 high-income adults. Low-income adults experienced improvements in insurance coverage (relative risk [RR], 1.10 [95% CI, 1.08–1.12]), access to a provider (RR, 1.12 [95% CI, 1.09–1.14]), and ability to afford care (RR, 1.07 [95% CI, 1.05–1.09]) in 2021 compared with 2019. While these measures also improved for high-income adults, gains in coverage and ability to afford care were more pronounced among low-income adults. However, routine visits (RR, 0.96 [95% CI, 0.94–0.98]) and cholesterol testing (RR, 0.93 [95% CI, 0.91–0.96]) decreased for low-income adults, while diabetes screening (RR, 1.01 [95% CI, 0.95–1.08]) remained stable. Treatment for hypertension (RR, 1.05 [95% CI, 1.02–1.08]) increased, and diabetes-focused visits and insulin use remained stable. These patterns were similar for high-income adults. Across most outcomes, there were no differential changes between low-income adults residing in Medicaid expansion versus nonexpansion states. CONCLUSIONS: In this national study of working-age adults in the United States, measures of health care access improved for low- and high-income adults in 2021. However, routine outpatient visits and cardiovascular risk factor screening did not return to prepandemic levels, while risk factor treatment remained stable. As many coronavirus disease-era safety net policies come to an end, targeted strategies are needed to protect health care access and improve cardiovascular risk factor screening for working-age adults.

中文翻译：

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大流行期间美国劳动年龄成年人的医疗保健获取和心血管危险因素管理

背景：在 2019 年冠状病毒病大流行开始时，低收入工作年龄的美国成年人不成比例地经历了医疗保健中断。人们对医疗保健获取和心血管危险因素管理如何随着大流行的持续而变化，或者模式是否因州医疗补助扩张状况而有所不同，知之甚少。 方法：使用行为风险因素监测系统的横截面数据，使用多变量泊松回归比较 2021 年（大流行）至 2019 年（大流行前）美国 18 至 64 岁成年人自我报告的医疗保健获取和心血管风险因素管理措施楷模。我们通过纳入收入组和年份的交互项来评估低收入（<138% 联邦贫困线）和高收入（>400% 联邦贫困线）工作年龄成年人之间的差异变化。然后，我们使用类似的方法评估了医疗补助扩张州与非扩张州低收入成年人的变化。 结果：未加权的研究人群包括 80 767 名低收入成年人和 184 136 名高收入成年人。低收入成年人的保险覆盖范围（相对风险 [RR]，1.10 [95% CI，1.08–1.12]）、获得医疗服务提供者的机会（RR，1.12 [95% CI，1.09–1.14]）以及获得服务的能力得到改善。与 2019 年相比，2021 年的医疗费用负担能力（RR，1.07 [95% CI，1.05–1.09]）。虽然这些措施对于高收入成年人也有所改善，但低收入成年人的覆盖率和负担能力的提高更为明显。然而，低收入成年人的常规就诊（RR，0.96 [95% CI，0.94-0.98]）和胆固醇检测（RR，0.93 [95% CI，0.91-0.96]）有所减少，而糖尿病筛查（RR，1.01 [ 95% CI，0.95–1.08]）保持稳定。高血压治疗（RR，1.05 [95% CI，1.02-1.08]）增加，以糖尿病为重点的就诊和胰岛素使用保持稳定。这些模式对于高收入成年人来说是相似的。在大多数结果中，居住在医疗补助扩张州与非扩张州的低收入成年人之间没有差异。 结论：在这项针对美国工作年龄成年人的全国性研究中，低收入和高收入成年人的医疗保健获取指标在 2021 年有所改善。然而，常规门诊就诊和心血管危险因素筛查并未恢复到大流行前的水平，而风险因素治疗保持稳定。随着许多冠状病毒疾病时代的安全网政策结束，需要有针对性的策略来保护医疗保健的可及性并改善对工作年龄成年人的心血管危险因素筛查。