High Blood Pressure Reduction, Health Insurance Status, and Social Deprivation Index in U.S. Community Health Centers.
High Blood Pressure Reduction, Health Insurance Status, and Social Deprivation Index in U.S. Community Health Centers.
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DOI：
10.1016/j.focus.2022.100018
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发表时间：
2022-12
期刊：
影响因子：
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通讯作者：
Marino, Miguel
中科院分区：
文献类型：
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作者：
Green, Beverly B;Larson, Annie E;Huguet, Nathalie;Angier, Heather;Valenzuela, Steele;Marino, Miguel
研究患者的平均血压为150/100毫米汞柱。从2012年到2017年，BP总体收缩压下降了21.7毫米汞，舒张压下降了11.1毫米汞柱。与未参保的患者相比，公共参保患者的收缩压下降幅度略大。与未参保的患者相比，公共或商业参保的患者对血压的控制更好。社区层面的社会剥夺与血压降低/控制无关。缺乏医疗保险是高血压失控的一个风险因素，但目前尚不清楚，随着时间的推移，医疗保险或社区层面的社会剥夺是否与血压的大幅下降有关。我们使用2012至2017年的电子健康记录数据估计了医疗保险和社会剥夺指数随时间的降低血压。我们纳入了年龄在19-之间，初始收缩压≥为150毫米汞或舒张压≥为100毫米汞的患者，以及来自93个社区卫生中心的≥1次额外就诊，这些州在2014年扩大了医疗补助计划。我们纳入了66,207名患者：20.1%没有保险，64.8%有公共保险，15.1%有私人保险。经患者特征和基线血压调整后，在研究期间，未参保、公共参保和私人参保的个人的收缩压/舒张压分别下降了21.3/11.2、22.0/11.4和21.1/10.7毫米汞。有公共保险的患者与未参加保险的患者相比，收缩压下降幅度较小，但差异显著(差值=−1.3，95%CI=−1.6，−1.0)，但与社会剥夺指数无关。随着时间的推移，保险状况或社会剥夺指数对舒张压降低的影响没有差异。在公共或商业保险个人中，血压控制(收缩压和舒张压分别为140毫米汞柱和90毫米汞)显著高于未参保个人(分别为51.7%、51.5%和44.6%，均为P<；0.001)，血压控制和社会剥夺指数之间没有关联。血压的下降幅度很大，但大多与保险类型或社会剥夺指数无关。还需要更多的研究来了解社区卫生中心环境中导致血压降低的因素。
Study patients on average had blood pressure (BP) >150/100 mmHg. BP declined overall by 21.7 mmHg systolic and 11.1 mmHg diastolic from 2012 to 2017. Systolic BP decreased slightly more among publicly insured than among noninsured patients. BP control was greater for public or commercially insured than for noninsured patients. Neighborhood-level social deprivation was not associated with BP reduction/control. Lack of health insurance is a risk factor for uncontrolled hypertension, but it is unknown whether health insurance or neighborhood-level social deprivation is associated with greater reductions in blood pressure over time. We estimated the association of health insurance and social deprivation index on blood pressure reduction over time using electronic health record data from 2012 to 2017. We included patients aged 19–64 years with an initial systolic blood pressure ≥150 mmHg or diastolic blood pressure ≥100 mmHg and ≥1 additional visit from 93 community health centers in states that expanded Medicaid in 2014. We included 66,207 patients: 20.1% uninsured, 64.8% publicly insured, and 15.1% privately insured. Adjusting for patient characteristics and baseline blood pressure, systolic blood pressure/diastolic blood pressure declined over the study period by 21.3/11.2 mmHg, 22.0/11.4 mmHg, and 21.1/10.7 mmHg among uninsured, publicly insured, and privately insured individuals, respectively. There were small but significantly greater reductions in systolic blood pressure among patients with public insurance than among those who were uninsured (difference= −1.3, 95% CI= −1.6, −1.0) but none associated with social deprivation index. There were no differences in diastolic blood pressure reductions over time by insurance status or social deprivation index. Blood pressure control (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) was significantly greater among publicly or commercially insured individuals than among uninsured individuals (51.7%, 51.5%, 44.6% respectively, both comparisons p<0.001), with no associations between blood pressure control and social deprivation index. Reductions in blood pressure were large but mostly not associated with insurance type or social deprivation index. Additional research is needed to understand the factors that lead to blood pressure reduction in community health center settings.