Association Between Insurance Gaps and Continued Antihypertension Medication Usage in a US National Representative Population

Gai, Yunwei; Gu, Nong

doi:10.1038/ajh.2009.188

Cited by 15 publications

(27 citation statements)

References 20 publications

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“…Higher control rates may reflect better treatment-togoal, perhaps reflecting a universal access, publicly funded healthcare system in Canada compared with the often more limited (at least up to the present) insurance system existing in the United States. 4,5 However, a publicly funded healthcare system, per se, is clearly not sufficient considering the persistent low control rates in Europe, eg, 28% in England. 6 Methodological aspects may also contribute to the difference in control rates in the United States versus Canada.…”

mentioning

confidence: 99%

Control Rates of Hypertension in North America

Leenen

Schiffrin

2010

Hypertension

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mentioning

confidence: 99%

Control Rates of Hypertension in North America

Leenen

Schiffrin

2010

Hypertension

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“…Persistence on antihypertensive medication is reportedly lower in uninsured than insured adults, 29 which could account for this observation (Figure 2). 6 Yet, in insured and uninsured adults on treatment, the number and classes of antihypertensive medications reportedly taken in the prior month were not different (S1 Table).…”

Section: Discussionmentioning

confidence: 95%

“…10,41,42 Hypertension control was similar in adults with public and private insurance, although publicly insured adults were more likely to be black or Hispanic, factors negatively associated with hypertension control. 3,16,29 Publicly insured adults had more obesity and diabetes than privately insured adults, two factors associated with BP control. Two factors restraining hypertension control in privately insured adults were the higher proportion of males and less frequent healthcare, which are linked to poorer hypertension control among adults 18–64 years.…”

Section: Discussionmentioning

confidence: 99%

The Growing Gap in Hypertension Control Between Insured and Uninsured Adults

Egan

Small

et al. 2014

Hypertension

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Hypertension awareness, treatment and control are lower among uninsured than insured adults. Time trends in differences and underlying modifiable factors are important for informing strategies to improve health equity. National Health and Nutrition Examination Surveys 1988–1994, 1999–2004, 2005–2010 data in adults 18–64 years were analyzed to explore this opportunity. The proportion of adults with hypertension who were uninsured increased from 12.3% in 1988–1994 to 17.4% in 2005–2010. In 1988–1994, hypertension awareness, treatment and control to <140/<90 millimeters mercury (30.1% versus 26.5, p=0.27) were similar in insured and uninsured adults. By 2005–2010, the absolute gap in hypertension control between uninsured and insured adults of 21.9% (52.5% versus 30.6%, p<0.001]) was explained approximately equally by lower awareness (65.2% versus 80.7%), fewer aware adults treated (75.2% versus 88.5%,and fewer treated adults controlled (63.1% versus 73.5% [all p<0.001]). Publicly insured and uninsured adults had similar income. Yet, hypertension control was similar across time periods in publicly and privately insured adults, despite lower income and education in the former. In multivariable analysis, hypertension control in 2005–2010 was associated with visit frequency (odds ratio 3.4, 95% confidence interval [2.4–4.8]), statin therapy (1.8 [1.4–2.3]) and healthcare insurance (1.6 [1.2–2.2]) but not poverty index (1.04 [0.96–1.12]). Public or private insurance linked to more frequent healthcare, greater awareness and effective treatment of hypertension, and appropriate statin use could reverse a long-term trend of growing inequity in hypertension control between insured and uninsured adults.

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“…19 One may speculate that the focus on prevention is similarly high in Canada and the United States, but that an efficient, publicly funded health-care system as exists in Canada provides better results than the often limited (if at all) existing private insurance coverage existing in the United States. 20,21 Strengths and limitations: The present survey provides contemporary data on obesity and hypertension in the province of Ontario. The major strength is clearly the direct measures of BP, height, and weight using a uniform, standardized approach.…”

Section: Original Contributionsmentioning

confidence: 99%