The growing gap in hypertension control between insured and uninsured adults: National Health and Nutrition Examination Survey 1988 to 2010.
The growing gap in hypertension control between insured and uninsured adults: National Health and Nutrition Examination Survey 1988 to 2010.
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DOI：
10.1161/hypertensionaha.114.04276
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发表时间：
2014-11
期刊：
影响因子：
--
通讯作者：
Sinopoli A
中科院分区：
文献类型：
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作者：
Egan BM;Li J;Small J;Nietert PJ;Sinopoli A
未投保的成年人对高血压的认识、治疗和控制低于投保的成年人。差异的时间趋势和潜在的可改变因素对于制定改善健康公平的战略非常重要。分析了1988-1994年、1999-2004年、2005-2010年18-64岁成年人的国家健康和营养调查数据，以探讨这一机会。没有保险的高血压成年人比例从1988-1994年的12.3%上升到2005-2010年的17.4%。在1988-1994年，高血压的认识，治疗和控制到<140/<90毫米汞柱（30.1%对26.5，p=0.27）在投保和未投保的成年人相似。到2005-2010年，未参保和参保成年人之间高血压控制的绝对差距为21.9%，（52.5%与30.6%，p<0.001]）意识较低的解释大致相同（65.2%对80.7%），较少的知晓成人接受治疗（75.2%对88.5%），较少的接受治疗的成人控制（63.1%对73.5% [所有p<0.001]）。有公共保险和没有保险的成年人收入相似。然而，在公共和私人保险的成年人中，高血压控制在不同时期是相似的，尽管前者的收入和教育程度较低。在多变量分析中，2005-2010年的高血压控制与就诊频率（比值比3.4，95%置信区间[2.4-4.8]）、他汀类药物治疗（1.8 [1.4-2.3]）和医疗保险（1.6 [1.2-2.2]）相关，但与贫困指数（1.04 [0.96-1.12]）无关。公共或私人保险与更频繁的医疗保健，提高对高血压的认识和有效治疗以及适当的他汀类药物使用有关，可以扭转投保和未投保成年人之间高血压控制日益不公平的长期趋势。
Hypertension awareness, treatment and control are lower among uninsured than insured adults. Time trends in differences and underlying modifiable factors are important for informing strategies to improve health equity. National Health and Nutrition Examination Surveys 1988–1994, 1999–2004, 2005–2010 data in adults 18–64 years were analyzed to explore this opportunity. The proportion of adults with hypertension who were uninsured increased from 12.3% in 1988–1994 to 17.4% in 2005–2010. In 1988–1994, hypertension awareness, treatment and control to <140/<90 millimeters mercury (30.1% versus 26.5, p=0.27) were similar in insured and uninsured adults. By 2005–2010, the absolute gap in hypertension control between uninsured and insured adults of 21.9% (52.5% versus 30.6%, p<0.001]) was explained approximately equally by lower awareness (65.2% versus 80.7%), fewer aware adults treated (75.2% versus 88.5%,and fewer treated adults controlled (63.1% versus 73.5% [all p<0.001]). Publicly insured and uninsured adults had similar income. Yet, hypertension control was similar across time periods in publicly and privately insured adults, despite lower income and education in the former. In multivariable analysis, hypertension control in 2005–2010 was associated with visit frequency (odds ratio 3.4, 95% confidence interval [2.4–4.8]), statin therapy (1.8 [1.4–2.3]) and healthcare insurance (1.6 [1.2–2.2]) but not poverty index (1.04 [0.96–1.12]). Public or private insurance linked to more frequent healthcare, greater awareness and effective treatment of hypertension, and appropriate statin use could reverse a long-term trend of growing inequity in hypertension control between insured and uninsured adults.