Journal
AMERICAN JOURNAL OF HYPERTENSION
Volume 34, Issue 7, Pages 707-717Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ajh/hpab011
Keywords
blood pressure; healthcare disparities; hypertension; social determinants
Categories
Funding
- American Heart Association [17SFRN33590069]
- National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) [T32 HL007024]
- National Institute of Health (NIH)/National Institute of Nursing Research(NINR) [P30 NR018093]
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The study found that social determinants independently influence hypertension outcomes in US adults. Policy interventions are urgently needed to address healthcare access and education, and eliminate racial disparities.
BACKGROUND Social determinants influence the development and control of hypertension. METHODS National Health and Nutrition Examination Survey (2011-2018) data for adults aged >= 18 included education, income, employment, race/ethnicity, healthcare access, marital status, and nativity status. Outcomes were hypertension (blood pressure [BP] >= 130/80 mm Hg or self-reported hypertension medication use), stage 2 hypertension (BP >= 140/90 mm Hg), and controlled BP (BP <130/80 mm Hg among those with hypertension). Poisson regression with robust variance estimates was used to examine associations between social determinants and outcomes, by sex. RESULTS The analysis included 21,664 adults (mean age 47.1 years), of whom 51% were women. After adjustment, hypertension and stage 2 hypertension prevalence remained higher among Black and Asian than White adults, regardless of sex. Blacks had lower prevalence of controlled BP than Whites. Compared with college graduates, men and women with less education had a higher prevalence of hypertension and stage 2 hypertension. Men (prevalence ratio [PR]: 0.28, 95% confidence interval: 0.16-0.49) and women (PR: 0.44, 0.24-0.78) with no routine place for healthcare had lower prevalence of controlled BP than those who had a routine place for healthcare. Uninsured men (PR: 0.66, 0.44-0.99) and women (PR: 0.67, 0.51-0.88) had lower prevalence of controlled BP than those insured. Unemployed or unmarried women were more likely to have controlled BP than employed or married women. CONCLUSIONS Social determinants were independently associated with hypertension outcomes in US adults. Policy interventions are urgently needed to address healthcare access and education, and eliminate racial disparities.
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