Introduction

This comprehensive position paper serves to provide recommendations aimed at supporting emergency physicians working in emergency departments, including those equipped with chest pain centers, in delivering thorough care for patients affected by acute cardiac ischemia. Diabetes mellitus has emerged as a significant global health crisis characterized by its severe complications. These complications encompass heightened morbidity and mortality rates attributable to coronary artery disease, notably myocardial infarction, as well as microvascular complications induced by diabetes. Furthermore, diabetes exhibits a disproportionate impact on racial and ethnic minority groups, thereby exacerbating existing health inequalities within the United States (US). Alarmingly, approximately one in three US adults presently grapples with a prediabetic condition, signaling an imminent risk of developing full-fledged diabetes. Despite evidence suggesting that modest weight reduction achieved through lifestyle modifications can forestall or attenuate the onset of diabetes, the majority of individuals with prediabetes remain unassessed or uninformed about their predisposition. Consequently, there exists a pressing need to enhance awareness and knowledge dissemination among this particularly vulnerable demographic, constituting a paramount public health imperative.

Fundamental concept

Understanding the perception of risk associated with developing diabetes and its correlation with the risk of heart attack is recognized as a fundamental concept that typically precedes actions such as screening for prediabetes and making lifestyle modifications. A crucial aspect of promoting such screening and lifestyle changes lies in ensuring that the general public possesses a comprehensive understanding of the risk factors associated with diabetes. This paper aimed to delve into the relationship between individuals' self-reported perceptions of their risk of developing diabetes or experiencing a heart attack and the often overlapping risk factors for these two medical conditions. This investigation encompassed a substantial and diverse sample of non-diabetic adults proficient in English, Spanish, and Korean. To the best of our knowledge, this study marked the inaugural comparative assessment of risk perception concerning diabetes and heart attack across all three languages. Given the burgeoning population of racial and ethnic minorities in the United States who are particularly susceptible to developing diabetes, the insights gleaned from this crosssectional survey are poised to offer novel perspectives for the screening and prevention of both diabetes and heart attack in the future. Through this research, a deeper understanding of the intricacies surrounding risk perception and its implications for preventive healthcare strategies is anticipated to emerge, thereby contributing to more effective approaches in addressing these prevalent and interrelated health concerns.

Hospital records

This paper delves into the intricate dynamics between uninsured patients and the in-hospital mortality rates of insured individuals suffering from heart attacks. Through a meticulous analysis, I utilize panel data models incorporating patient discharge records and hospital financial data sourced from California. The findings I present demonstrate a notable and economically significant impact of uninsured patients, leading to an increase in the mortality rate among insured heart attack patients. Importantly, I rigorously examine various potential explanations, such as reverse causality, patient demographics, sample selection biases, and unobserved trends, ensuring the robustness of my conclusions. I elucidate that the observed spillover effects primarily stem from heightened hospital uncompensated care costs. Although the available data limits my ability to thoroughly investigate how hospitals adjust their care provision to insured heart attack patients in response to decreased revenues, the evidence suggests a modest uptick in the volume of cardiac services provided without a corresponding increase in hospital staffing. Over recent decades, the healthcare landscape in the United States has undergone profound transformations. Despite these shifts, one constant has been the persistent issue of a large segment of the population lacking health insurance coverage. Consequently, the challenge of the uninsured has remained a focal point in public policy discussions. While ample research exists on how the absence of insurance impacts an individual's own health outcomes, healthcare utilization, and economic welfare, there exists a notable gap in understanding how the uninsured influence the delivery of care to insured patients. This study aims to address this gap and contribute to a deeper understanding of the broader implications of uninsured populations within the healthcare system.