Examining Neighborhood Socioeconomic Status as a Mediator of Racial/Ethnic Disparities in Hypertension Control Across Two San Francisco Health Systems.
Examining Neighborhood Socioeconomic Status as a Mediator of Racial/Ethnic Disparities in Hypertension Control Across Two San Francisco Health Systems.
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DOI：
10.1161/circoutcomes.121.008256
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Lyles CR
中科院分区：
文献类型：
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作者：
Liu EF;Rubinsky AD;Pacca L;Mujahid M;Fontil V;DeRouen MC;Fields J;Bibbins-Domingo K;Lyles CR
对高血压控制的背景理解可以为人群健康管理策略提供信息，以减轻心血管疾病事件。本回顾性队列研究将社区水平的数据与患者的健康记录联系起来，以描述未控制高血压的种族/民族差异，并确定这些差异是否以及在多大程度上由nSES介导。我们对来自旧金山两家医疗服务系统的高血压患者样本进行了中介分析（n = 47,031）。我们使用广义结构方程模型，对年龄、性别和医疗保健系统进行调整，分别估计nSES对白人患者与黑人、西班牙裔/拉丁裔和亚洲患者之间未控制高血压差异的贡献。敏感性分析剔除了对医疗系统的调整。超过一半的队列（62%）在研究期间经历了不受控制的高血压。种族/民族在未控制的高血压患病率和nSES五分位数分布方面存在显著差异。与白人患者相比，黑人和西班牙裔/拉丁裔患者高血压未控制的调整几率更高：OR = 1.79, 95% CI: 1.67, 1.91和OR = 1.38, 95% CI: 1.29, 1.47， nSES占两种比较差异的7%。与白人患者相比，亚裔患者高血压未控制的调整几率略低：OR = 0.95, 95% CI: 0.89, 0.99， nSES的中介作用没有改变关系的方向。敏感性分析将nSES介导的比例在黑人和白人患者中增加到11%，在西班牙裔/拉丁裔和白人患者中增加到13%，但不影响亚洲和白人患者之间的差异。在本研究的高血压患者中，nSES介导了一小部分未控制高血压的种族/民族差异。人口健康管理战略最有效的办法可能是侧重于其他结构和人际途径，如卫生保健环境中的种族主义和歧视。
A contextual understanding of hypertension control can inform population health management strategies to mitigate cardiovascular disease events. This retrospective cohort study links neighborhood-level data with patients’ health records to describe racial/ethnic differences in uncontrolled hypertension and determine if and to what extent these differences are mediated by nSES. We conducted a mediation analysis using a sample of patients with hypertension from two healthcare delivery systems in San Francisco over two years (n = 47,031). We used generalized structural equation modeling, adjusted for age, sex, and healthcare system, to estimate the contribution of nSES to disparities in uncontrolled hypertension between White patients and Black, Hispanic/Latino, and Asian patients, respectively. Sensitivity analysis removed adjustment for healthcare system. Over half the cohort (62%) experienced uncontrolled hypertension during the study period. Racial/ethnic groups showed substantial differences in prevalence of uncontrolled hypertension and distribution of nSES quintiles. Compared to White patients, Black and Hispanic/Latino patients had higher adjusted odds of uncontrolled hypertension: OR = 1.79, 95% CI: 1.67, 1.91 and OR = 1.38, 95% CI: 1.29, 1.47, respectively, and nSES accounted for 7% of the disparity in both comparisons. Asian patients had slightly lower adjusted odds of uncontrolled hypertension when compared to White patients: OR = 0.95, 95% CI: 0.89, 0.99, and the mediating effect of nSES did not change the direction of the relationship. Sensitivity analysis increased the proportion mediated by nSES to 11% between Black and White patients and 13% between Hispanic/Latino and White patients, but did not influence differences between Asian and White patients. Among patients with hypertension in this study, nSES mediated a small proportion of racial/ethnic disparities in uncontrolled hypertension. Population health management strategies may be most effective by focusing on additional structural and interpersonal pathways such as racism and discrimination in health care settings.