Sex Differences in Healthcare Utilization and Costs among Individuals with Elevated Blood Pressure: The LARK Study from Western Kenya

Abstract

Background: Elevated blood pressure is the leading risk factor for global mortality. While it is known that there exist differences between men and women with respect to socioeconomic status, self-reported health, and healthcare utilization, there are few published studies from Africa. This study therefore aims to characterize differences in healthcare utilization and costs between men and women with elevated blood pressure in Kenya.Methods: Data from 1447 participants enrolled in the LARK Hypertension study in western Kenya were analyzed. Latent class analysis based on nine dependent variables was performed to describe patterns of healthcare utilization and costs in the study population. Regression analysis was then performed to describe the relationship between different demographics and each outcome. Results: Women in our study had higher rates of unemployment (28% vs 12%), were more likely to report lower monthly earnings (72% vs 51%), and had more outpatient visits (39% vs 28%) and pharmacy prescriptions (42% vs 30%). Three patterns of healthcare utilization were described: (1) individuals with low healthcare utilization, (2) individuals who utilized care but paid low out-of-pocket costs, and (3) individuals who utilized care but had higher out-of-pocket costs. Women and those with health insurance were more likely to be in the high-cost utilizer group. Women were also more likely to report lower quality-of-life and functional health status, including pain, mobility, self-care, and ability to perform usual activities. Conclusions: Men and women with elevated blood pressure in Kenya have different health care utilization behaviors, cost and economic burdens, and health outcomes. Awareness of these sex differences can help inform targeted interventions in these populations. Trial registration: ClinicalTrials.gov Identifier: NCT01844596, Date of registration: May 1, 2013. https://clinicaltrials.gov/ct2/show/NCT01844596