Social Determinants of Health and Hypertension Control in Adults with Medicaid

Abstract

Background: Social determinants of health (SDOH) are associated with cardiovascular disease, but little is known about mechanisms underlying those relationships. We hypothesized that SDOH would be associated with uncontrolled hypertension (HTN) in adults with Medicaid. Methods: This was a retrospective analysis of adults in a Medicaid accountable care organization who had HTN diagnoses, received regular care at community health centers, and enrolled in a cohort study between December 2019 and December 2020. Baseline surveys collected demographics and SDOH, including food insecurity, unstable housing, cost-related medication underuse, and financial stress. Blood pressure (BP) measurements over 12 months after survey completion were obtained from the electronic health record. Participants were categorized as: uncontrolled HTN (mean systolic BP ≥ 140 mm Hg and/or mean diastolic BP ≥ 90 mm Hg), controlled HTN, or unknown HTN control (no BP documented). We examined the association of individual and cumulative (count, 0-4) SDOH with uncontrolled HTN and unknown HTN control using multivariable logistic regression adjusting for demographics, smoking, diabetes, and HTN medication. Results: Participants (n = 245) were mean (SD) age 51.3 (8.6) years, 66.1% female, 43.7% Hispanic, 34.3% White, and 18.0% Black. Overall, 58.0% had food insecurity, 38.0% had unstable housing, 29.4% had financial stress, and 20.0% reported cost-related medication underuse. BP was documented for 180 participants; 44 (24.4%) had uncontrolled HTN. In multivariable models, neither individual nor cumulative SDOH were associated with uncontrolled HTN or unknown HTN control. Conclusions: In a Medicaid-insured population receiving care at community health centers, adverse SDOH were prevalent but were not associated with HTN control.

Sociodemographic and Behavioral Factors Associated with Diet Quality among Low-income Community Health Center Patients with Hypertension

“…In this analysis, we used information extracted from the electronic health record in the Enterprise Data Warehouse to categorize blood pressure control, expanding upon the work from our previous publication (26) where uncontrolled blood pressure was determined via research patient data registry records only. Hypertension was considered uncontrolled if mean systolic blood pressure ≥ 140 mm Hg or mean diastolic blood pressure ≥ 90 mm Hg in the 12 months prior to baseline.…”

Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions

“…Another major category included healthcare utilization metrics like preventable hospital readmissions (n = 11) [136][137][138][139][140][141][142][143][144][145], ED reliance ( n = 16) , and telehealth adoption [169]. Beyond infectious outcomes and healthcare utilization, studies also assessed chronic disease control across conditions like diabetes (n = 11) [170][171][172][173][174][175][176][177][178][179][180], hypertension [173,181,182], kidney disease [183,184], and obesity (n = 7) [146,175,[185][186][187][188][189], along with risk factors like elevated blood pressure and cardiovascular events. Some studies focused on cancer (n = 11) screening, diagnoses, treatment disparities and survival outcomes [167,[190][191][192][193][194][195][196][197][198]…”

“…In our review, we identified 164 articles (details see Supplement 168], and telehealth adoption [169]. Beyond infectious outcomes and healthcare utilization, studies also assessed chronic disease control across conditions like diabetes (n = 11) [170][171][172][173][174][175][176][177][178][179][180], hypertension [173,181,182], kidney disease [183,184], and obesity (n = 7) [146,175,[185][186][187][188][189], along with risk factors like elevated blood pressure and cardiovascular events. Some studies focused on cancer (n = 11) screening, diagnoses, treatment disparities and survival outcomes [167,[190][191][192][193][194][195][196][197][198][199], while others addressed mental health (n = 6) indicators [146][147][148][149][150][151] ranging from dementia incidence [200] to suicide (n = 2) risk factors [201,202].…”