Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware

Abstract

ImportanceThe association between degree of neighborhood deprivation and primary hypertension diagnosis in youth remains understudied.ObjectiveTo assess the association between neighborhood measures of deprivation and primary hypertension diagnosis in youth.Design, Setting, and ParticipantsThis cross-sectional study included 65 452 Delaware Medicaid-insured youths aged 8 to 18 years between January 1, 2014, and December 31, 2019. Residence was geocoded by national area deprivation index (ADI).ExposuresHigher area deprivation.Main Outcomes and MeasuresThe main outcome was primary hypertension diagnosis based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Data were analyzed between September 1, 2021, and December 31, 2022.ResultsA total of 65 452 youths were included in the analysis, including 64 307 (98.3%) without a hypertension diagnosis (30 491 [47%] female and 33 813 [53%] male; mean [SD] age, 12.5 (3.1) years; 12 500 [19%] Hispanic, 25 473 [40%] non-Hispanic Black, 24 565 [38%] non-Hispanic White, and 1769 [3%] other race or ethnicity; 13 029 [20%] with obesity; and 31 548 [49%] with an ADI ≥50) and 1145 (1.7%) with a diagnosis of primary hypertension (mean [SD] age, 13.3 [2.8] years; 464 [41%] female and 681 [59%] male; 271 [24%] Hispanic, 460 [40%] non-Hispanic Black, 396 [35%] non-Hispanic White, and 18 [2%] of other race or ethnicity; 705 [62%] with obesity; and 614 [54%] with an ADI ≥50). The mean (SD) duration of full Medicaid benefit coverage was 61 (16) months for those with a diagnosis of primary hypertension and 46.0 (24.3) months for those without. By multivariable logistic regression, residence within communities with ADI greater than or equal to 50 was associated with 60% greater odds of a hypertension diagnosis (odds ratio [OR], 1.61; 95% CI 1.04-2.51). Older age (OR per year, 1.16; 95%, CI, 1.14-1.18), an obesity diagnosis (OR, 5.16; 95% CI, 4.54-5.85), and longer duration of full Medicaid benefit coverage (OR, 1.03; 95% CI, 1.03-1.04) were associated with greater odds of primary hypertension diagnosis, whereas female sex was associated with lower odds (OR, 0.68; 95%, 0.61-0.77). Model fit including a Medicaid-by-ADI interaction term was significant for the interaction and revealed slightly greater odds of hypertension diagnosis for youths with ADI less than 50 (OR, 1.03; 95% CI, 1.03-1.04) vs ADI ≥50 (OR, 1.02; 95% CI, 1.02-1.03). Race and ethnicity were not associated with primary hypertension diagnosis.Conclusions and RelevanceIn this cross-sectional study, higher childhood neighborhood ADI, obesity, age, sex, and duration of Medicaid benefit coverage were associated with a primary hypertension diagnosis in youth. Screening algorithms and national guidelines may consider the importance of ADI when assessing for the presence and prevalence of primary hypertension in youth.

Mapping Health Disparities:

“…Individual research and publications use the ADI in studies on chronic conditions to great effect, such as the study which recently found that in Delaware Medicaid recipients between the ages of 8 and 18 “communities with ADI greater than or equal to 50 was associated with 60% greater odds of a hypertension diagnosis.” 15 However, at the enterprise level, health systems and insurers alike are slow to take on the cost and effort associated with a comprehensive geocoding strategy that would allow rapid iterations of these kinds of analysis within chronic disease management programs.…”

A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association

“…2 With the changing landscape of atherosclerosis that has shifted to developing countries, women, and younger individuals, current knowledge gaps include an incomplete understanding of (1) sex differences in CVD in CKM syndrome, (2) genetic underpinnings of disease that may account for some regional differences and clinical applications of genetic testing, (3) mechanisms of endothelial dysfunction in CKM syndrome (accelerated in the presence of CKD 42 ) as an early harbinger of CVD, and (4) environmental and community-level risk factors in the development of CVD. 43 In contrast to atherosclerosis, mechanisms by which CKM syndrome leads to HF and arrhythmias (and, in particular, atrial fibrillation [AFib]) are less well described. Adiposity itself leads to hemodynamic changes.…”

Where a child lives matters: neighborhood deprivation and pediatric obesity

“…Higher area deprivation is associated with greater odds of a hypertension diagnosis among youth. According to a cross-sectional analysis of 65 452 Delaware Medicaid recipients, 8–18 years of age, patient level factors associated with greater odds of a hypertension diagnosis were obesity diagnosis (OR 5.16; 95% CI, 4.54–5.85), older age (1.16; 95% CI, 1.14–1.18), and ADI greater than or equal to 50 (OR 1.61; 95% CI, 1.04–2.51), the state's upper quartile cutoff [30 ▪ ].…”