Despite increased healthcare outreach, an uptick in publicly and privately insured Americans and an effort to clear socioeconomic hurdles, U.S. rates of uncontrolled low-density lipoprotein cholesterol (LDL-C) aren’t improving in uninsured populations, according to recent research published in the Journal of the American Heart Association.

Income, health coverage, frequency of health care and minority race-ethnicity status are all strong predictors of diagnosis, treatment and control of hypercholesterolemia, first author Brent M. Egan, MD, and colleagues wrote in the study—that much is known. But although clinicians are aware of those facts, data on the gaps in LDL cholesterol control between insured and uninsured citizens are lacking, and recent research has suggested healthcare isn’t all attributable to a patient’s funds.

“Of the variables affecting medical management of hypercholesterolemia, healthcare insurance emerges as more amenable to change than income or race-ethnicity,” the authors wrote. “Moreover, evidence suggests that higher incomes do not overcome lack of insurance in obtaining healthcare services for cardiovascular risk reduction.”

Egan et al. screened information from nearly 10,000 adults, aged 21 to 64, for this analysis, according to the study, in an effort to compare LDL-C control among privately and publicly insured and uninsured U.S. adults. All data was collected by the National Center for Health Statistics and was compiled in annual National Health and Nutrition Examination Surveys (NHANES) between 2001 and 2012.

Using Adult Treatment Panel-3 criteria, Egan and his team found that LDL-C control improved similarly over time in both privately and publicly insured adults but remained stagnant among the uninsured population. Although access to insurance, socioeconomic status and other variables were contributors to treatment and control patterns, the researchers found frequency of health care was a strong positive predictor of LDL cholesterol control and treatment. On the other hand, income greater than 200 percent above the federal poverty line was a strong negative predictor of control.

“Less frequent health care emerged as more important than race-ethnicity, income and education in accounting for differences in low-density lipoprotein cholesterol between insured and uninsured adults,” the authors wrote, noting that patients who visited the doctor more often were more likely to be aware and in control of their cholesterol.

Of the millions of adults classified as having LDL-C in the selected NHANES data, 18.1 percent were uninsured, Egan and co-authors wrote—a group that was less likely to be white and financially well-off, more likely to be young and were largely absent from the healthcare system, averaging around two visits per year. In these patients, hypercholesterolemia was consistently controlled in just 1 in 9 to 10 adults, increasing the disparity in LDL-C control between insured and uninsured groups from 10.9 percent to 23.8 percent during the course of study

Treatment and control of high LDL-C increased over time in both privately and publicly insured patients during this time frame, the authors wrote, but stayed stagnant in uninsured individuals.

Egan and colleagues said the information collected in this analysis could be helpful for informing healthcare policy, education and health delivery strategies to prevent cardiovascular disease across the country.

“Healthcare insurance largely addresses socioeconomic barriers to effective LDL-C management, yet poverty retains an independent adverse effect,” they wrote. “An important initial step in managing hypercholesterolemia is awareness.”