Rates of Undiagnosed Hypertension and Diagnosed Hypertension Without Anti-hypertensive Medication Following the Affordable Care Act.
Affordable Care Act
Medicaid expansion
blood pressure
community health center
hypertension
medication
Journal
American journal of hypertension
ISSN: 1941-7225
Titre abrégé: Am J Hypertens
Pays: United States
ID NLM: 8803676
Informations de publication
Date de publication:
22 09 2021
22 09 2021
Historique:
received:
22
12
2020
revised:
07
04
2021
accepted:
28
04
2021
pubmed:
1
5
2021
medline:
15
12
2021
entrez:
30
4
2021
Statut:
ppublish
Résumé
The Affordable Care Act (ACA) Medicaid expansion improved access to health insurance and health care services. This study assessed whether the rate of patients with undiagnosed hypertension and the rate of patients with hypertension without anti-hypertensive medication decreased post-ACA in community health center (CHC). We analyzed electronic health record data from 2012 to 2017 for 126,699 CHC patients aged 19-64 years with ≥1 visit pre-ACA and ≥1 post-ACA in 14 Medicaid expansion states. We estimated the prevalence of patients with undiagnosed hypertension (high blood pressure reading without a diagnosis for ≥1 day) and the prevalence of patients with hypertension without anti-hypertensive medication by year and health insurance type (continuously uninsured, continuously insured, gained insurance, and discontinuously insured). We compared the time to diagnosis or to anti-hypertensive medication pre- vs. post-ACA. Overall, 37.3% of patients had undiagnosed hypertension and 27.0% of patients with diagnosed hypertension were without a prescribed anti-hypertensive medication for ≥1 day during the study period. The rate of undiagnosed hypertension decreased from 2012 through 2017. Those who gained insurance had the lowest rates of undiagnosed hypertension (2012: 14.8%; 2017: 6.1%). Patients with hypertension were also more likely to receive anti-hypertension medication during this period, especially uninsured patients who experienced the largest decline (from 47.0% to 8.1%). Post-ACA, among patients with undiagnosed hypertension, time to diagnosis was shorter for those who gained insurance than other insurance types. Those who gained health insurance were appropriately diagnosed with hypertension faster and more frequently post-ACA than those with other insurance types. Trial Number NCT03545763.
Sections du résumé
BACKGROUND
The Affordable Care Act (ACA) Medicaid expansion improved access to health insurance and health care services. This study assessed whether the rate of patients with undiagnosed hypertension and the rate of patients with hypertension without anti-hypertensive medication decreased post-ACA in community health center (CHC).
METHODS
We analyzed electronic health record data from 2012 to 2017 for 126,699 CHC patients aged 19-64 years with ≥1 visit pre-ACA and ≥1 post-ACA in 14 Medicaid expansion states. We estimated the prevalence of patients with undiagnosed hypertension (high blood pressure reading without a diagnosis for ≥1 day) and the prevalence of patients with hypertension without anti-hypertensive medication by year and health insurance type (continuously uninsured, continuously insured, gained insurance, and discontinuously insured). We compared the time to diagnosis or to anti-hypertensive medication pre- vs. post-ACA.
RESULTS
Overall, 37.3% of patients had undiagnosed hypertension and 27.0% of patients with diagnosed hypertension were without a prescribed anti-hypertensive medication for ≥1 day during the study period. The rate of undiagnosed hypertension decreased from 2012 through 2017. Those who gained insurance had the lowest rates of undiagnosed hypertension (2012: 14.8%; 2017: 6.1%). Patients with hypertension were also more likely to receive anti-hypertension medication during this period, especially uninsured patients who experienced the largest decline (from 47.0% to 8.1%). Post-ACA, among patients with undiagnosed hypertension, time to diagnosis was shorter for those who gained insurance than other insurance types.
CONCLUSIONS
Those who gained health insurance were appropriately diagnosed with hypertension faster and more frequently post-ACA than those with other insurance types.
CLINICAL TRIALS REGISTRATION
Trial Number NCT03545763.
Identifiants
pubmed: 33929496
pii: 6261055
doi: 10.1093/ajh/hpab069
pmc: PMC8457435
doi:
Substances chimiques
Antihypertensive Agents
0
Banques de données
ClinicalTrials.gov
['NCT03545763']
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
989-998Subventions
Organisme : NCI NIH HHS
ID : R01 CA204267
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL136575
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© American Journal of Hypertension, Ltd 2021. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Références
Am J Hypertens. 2019 Sep 24;32(10):1030-1038
pubmed: 31232456
Ann Fam Med. 2014 Jul;12(4):352-8
pubmed: 25024244
Jt Comm J Qual Patient Saf. 2018 Mar;44(3):117-129
pubmed: 29499808
J Clin Hypertens (Greenwich). 2017 Jun;19(6):611-613
pubmed: 28466516
MMWR Morb Mortal Wkly Rep. 2018 Jul 27;67(29):798-802
pubmed: 30048423
Am J Hypertens. 2019 Sep 24;32(10):932-934
pubmed: 31310272
Am J Public Health. 2003 Dec;93(12):2051-4
pubmed: 14652333
Am J Prev Med. 2015 Feb;48(2):229-233
pubmed: 25442228
Am J Prev Med. 2017 Dec;53(6S2):S213-S219
pubmed: 29153123
Curr Hypertens Rep. 2014 Oct;16(10):481
pubmed: 25139779
Prev Med. 2019 Jul;124:91-97
pubmed: 31077723
J Am Board Fam Med. 2013 May-Jun;26(3):271-8
pubmed: 23657695
J Gen Intern Med. 2020 Apr;35(4):1292-1295
pubmed: 31898120
J Clin Epidemiol. 2008 Dec;61(12):1234-1240
pubmed: 18619805
Am J Hypertens. 2015 Sep;28(9):1091-7
pubmed: 25631381
Arch Intern Med. 2002 May 13;162(9):1051-8
pubmed: 11996617
MMWR Suppl. 2013 Nov 22;62(3):144-8
pubmed: 24264505
J Am Coll Cardiol. 2019 Jan 29;73(3):317-335
pubmed: 30678763
J Health Care Poor Underserved. 2019;30(1):116-130
pubmed: 30827973
NCHS Data Brief. 2017 Apr;(278):1-8
pubmed: 28463104
Health Aff (Millwood). 2015 Sep;34(9):1554-62
pubmed: 26355058
Ann Fam Med. 2019 Jul;17(4):336-344
pubmed: 31285211
J Am Board Fam Med. 2018 Nov-Dec;31(6):905-916
pubmed: 30413546
Circulation. 2020 Mar 3;141(9):e139-e596
pubmed: 31992061
Diabetes Care. 2018 Jan;41(Suppl 1):S86-S104
pubmed: 29222380
Diabetes Care. 2015 May;38(5):833-7
pubmed: 25802324
J Racial Ethn Health Disparities. 2019 Jun;6(3):517-524
pubmed: 30607576
Ann Intern Med. 2016 Jun 21;164(12):795-803
pubmed: 27088438
BMC Health Serv Res. 2014 Nov 19;14:585
pubmed: 25406509
Ann Epidemiol. 2008 Oct;18(10):803-12
pubmed: 18922396
JAMA. 2017 Jan 10;317(2):165-182
pubmed: 28097354
Med Care. 2020 Jun;58 Suppl 6 Suppl 1:S46-S52
pubmed: 32412953
JAMA. 2014 Nov 19;312(19):1973-4
pubmed: 25399269
JAMA. 2000 Oct 25;284(16):2061-9
pubmed: 11042754
JAMA. 2020 Sep 22;324(12):1190-1200
pubmed: 32902588