All ETDs from UAB

Advisory Committee Chair

David J Becker

Advisory Committee Members

Suzanne E Judd

Meredith L Kilgore

Julie L Locher

Paul Muntner

Document Type

Dissertation

Date of Award

2015

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

This dissertation comprises a series of studies conducted on modifiable risk factors as they contribute to cardiovascular health and disease and their associated health service expenditures and utilization. Specific topics in this compilation include (1) exploring the role of dietary sodium and potassium intake in cardiovascular health and disease; (2) examination of direct health expenditures in the Medicare-linked REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort as associated with Life’s Simple 7 (LS7), a composite measure of cardiovascular health defined by the American Heart Association (AHA) that is based on seven modifiable risk factors (blood pressure, blood cholesterol, blood glucose, smoking status, physical activity, healthy weight, and healthy diet); and, (3) further investigation of the contribution of diet by characterizing the association of a cardioprotective dietary pattern, the Mediterranean diet (MeD), with direct health service expenditures in the Medicare-linked REGARDS cohort. In the first paper, randomized trials were reviewed to provide a synthesis of the evidence on the effect of dietary salt intake reduction or increased potassium intake on blood pressure, target organ damage, cardiovascular disease, and mortality in the US population. Dietary guidelines and recommendations were outlined, current controversies regarding the evidence were discussed, and recommendations were made based on review of the evidence. In the second paper, we examined participant health service expenditures as associated with participants’ number of ideal LS7 factors. Expenditures were classified by total, inpatient, and outpatient health service categories and CVD-attributed costs were also characterized. Paper three expounds on the previous work by focusing on the contribution of participant adherence to the MeD with associated health service expenditures; and, these expenditures are detailed by total, inpatient, and outpatient health service categories. These studies contribute to the field of public health policy and economics in the context of linking participant data in a prospective cohort study with their respective administrative claims data to examine modifiable cardiovascular risk factor metrics with associated healthcare expenditures and utilization. This provides information that stakeholders can use to improve health outcomes, evaluate health services and procedures, and ensure healthcare value.

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