Associations Between Social Determinants and Hypertension, Stage 2 Hypertension, and Controlled Blood Pressure Among Men and Women in the United States

Abstract

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 to college graduates, men and women with less education had a higher prevalence of hypertension and stage 2 hypertension. Men (Prevalence Ratio [P.R.]: 0.28, 95% confidence interval [CI]: 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.

Moving Towards Equity With Digital Health Innovations for Stroke Care

“…5 stroke risk. SDOH encompass key characteristics like low socioeconomic status, 13 limited English proficiency, 14 food insecurity and underinsurance, [15][16][17] which are welldocumented to pose challenges for stroke prevention.…”

Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension

“… 14 Evidence for this is found in a recent NHANES analysis; SDoH were associated with hypertension, stage 2 hypertension, and controlled BP. 15 Hypertension prevalence was higher in NH Black and NH Asian adults than NH White adults. Lack of routine place for health care and being uninsured was associated with uncontrolled hypertension.…”

“…Lack of routine place for health care and being uninsured was associated with uncontrolled hypertension. 15 …”

Exploring Feasibility of mHealth to Manage Hypertension in Rural Black Older Adults: A Convergent Parallel Mixed Method Study

“…The reason for the high prevalence of HTN among Black adults is multifaceted and extends from the social determinates of health to societal-level disparities influenced by the effects of systemic and structural racism. 4 , 5 In older adult rural populations, the social and systemic inequities that influence health disparities are accentuated by higher poverty rates, multiple chronic health conditions, limited access to health care, and less health promoting behaviors that are more pronounced in Black than White older adults. 6 Likewise, the risk of HTN-related cardiovascular disease in rural populations is higher, especially among women who have additional cardiovascular risk factors because they are more likely to be older, poorer, uninsured, less educated, socially isolated, lack access to health services, and have higher rates of chronic disease.…”