Socioeconomic Factors Influencing the Failure to Measure the Blood Pressure of Children During Clinical Examinations

Abstract

The authors measured the percentage of children aged 6 through 17 whose blood pressure (BP) was not measured during recent nonemergency clinical examination and assessed the relative importance of health, ability-to-pay, language, and race-ethnic factors in determining whether BP was measured. Using a pooled dataset from the Medical Expenditure Panel Survey (MEPS) for 2006 and 2007, the authors calculated the percentage of children whose BP was not measured using a sample of children aged 6 through 17 and constructed a logistic regression model to estimate the relative importance of health, economic, and social factors in the examiner's decision to measure BP. A total of 28.9% of children did not have their BP measured. Within this unmeasured group, 31% had a family history of hypertension, 9% had a family history of diabetes, and 5% had a body mass index 32 kg ⁄ m 2 . The logistic regression model of examiners' decisions indicates that social and economic factors strongly compete with health factors in determining which children not to measure. While examiners place many children at risk for hypertension in the measured pool, they also place many at-risk children in the unmeasured pool for economic and social reasons. J Clin Hypertens (Greenwich). 2011;13:767-773. Ó2011 Wiley Periodicals, Inc.The prevalence of hypertension among children and adolescents in the United States is estimated to be between 3% and 5%.1,2 Factors related to higher blood pressure (BP) among children and adolescents are obesity ⁄ overweight, 3-12 low birth weight, 13-15 family history of hypertension, 16,17 and poor sleep quality.18 Non-Hispanic blacks and Mexican American children are at higher risk for prehypertension and hypertension compared with non-Hispanic white children. 12,19,20 In addition, lower socioeconomic status predicts hypertension. 21 Current guidelines recommend that all children 3 years and older have their BP measured at each health care visit. 13 It is known that this recommendation is often not followed by providers. 22 Despite this prevalence, due to the complexity of the definition for hypertension among children, even when BP is measured, Falkner and colleagues 2 argue that hypertension in children is underdiagnosed because it is easily missed, even by health professionals. Underdiagnosed hypertension can damage organs and cause early cardiovascular-related disease in early adulthood. 2,14However, underdiagnosis can also occur simply by failing to measure BP. Factors known to discourage routine testing include patient characteristics that predict normal BP such as younger age, female sex, low body mass index (BMI), and an absence of cardiovascular disease in the family. 22 We find that factors associated with inability-to-pay, English-language handicaps, and minority status also discourage BP measurement. Here we show that in the Medical Expenditure Panel Survey (MEPS), a nationally representative sample of nonemergency clinic and hospital visits in 2006-2007, examiners did not measure the BP of 34% of children ...

It's all about the children: a participant-driven photo-elicitation study of Mexican-origin mothers' food choices

“…Unfortunately, there is very little literature that discusses the capacity of low-income Mexican-origin women living in border or other underserved areas, and practices employed in care-giving or food provisioning [59]. Related literature does suggest that low-income women and mothers utilize a range of food choice strategies, or every day practices as observed here, to reduce hardships associated with food insecurity [5,69,70]. In a study of diverse Latino families in a relatively small metropolitan area, a Mexican mother explained how she dealt with inadequate benefits with, "where three eat, the fourth can, too" [5], which was similar to these mothers.…”