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Neighborhood-Level Disparities in Hypertension
Quick Takes
- Socioeconomically disadvantaged neighborhoods contributed to lack of identification and treatment of hypertension in middle-aged adults.
- Black patients face higher rates of hypertension and are undertreated compared to other racial groups. Addressing systemic and structural racism is key to finding solutions to these disparities.
Study Questions:
Does hypertension burden and treatment vary across neighborhoods based on socioeconomic disadvantage and racial or ethnic composition?
Methods:
This cross-sectional study analyzed adults aged 35-50 years in Cuyahoga County, Ohio, where the patients had ≥1 primary care visit during the year 2019, within the Cleveland Clinic Health System or MetroHealth System. The area deprivation index (ADI) was derived from the US Census Block Group level (neighborhood) in Ohio from 2015-2019 and included the following measures: income, education, housing, and occupation. These were rated on a scale of 40-160, where a higher score indicated greater disadvantage. Racial and ethnic categories for this study included: Asian, Hispanic, non-Hispanic Black, and non-Hispanic White. Health was characterized with the following comorbidities documented at the time of first visit: type 2 diabetes, lipid or metabolic disorders, coronary artery disease, chronic kidney disease, cerebrovascular disease, depression disorders, anxiety disorders, tobacco use, alcohol use, and substance abuse.
Results:
Included in results were 56,387 patients with a median age 43.1 years, 59.8% female, and 40.2% male. Patients living in the area of least resources (highest ADI quintile) included 21.6% and 31.2% lived in the area with the most resources (lowest ADI quintile). Breakdown of race and ethnicity included Asian 3.4%, Black 31.1%, Hispanic 5.5%, and White 60.0%. Those living in the highest ADI quintiles were 61.2% Black and 24.6% White, in contrast to the lowest ADI quintile, which included 7% Black and 86.1% White.
Patients residing in neighborhoods in the highest ADI quintile had a higher prevalence of hypertension (50.7% vs. 25.5%) and lower treatment rates (61.3% vs. 64.5%). A gradient in hypertension prevalence across ADI quintiles for almost all racial and ethnic groups was identified. When analyzing ADI quintiles, men consistently had higher rates of hypertension than women. However, the difference was smallest between Black men and women, especially in the most disadvantaged neighborhoods. Overall, Black men (56.5%) and women (51.4%) had the highest rates of hypertension compared to all other racial and ethnic groups.
Conclusions:
The researchers in this study have identified a significant disparity among disadvantaged neighborhoods with increased prevalence and undertreatment of hypertension. Black adults in midlife experience higher rates of hypertension, which was shown to persist across levels of socioeconomic disadvantage. Additionally, living in socioeconomically disadvantaged neighborhoods was associated with increased rates of hypertension across all racial and ethnic backgrounds. The authors identified treatment disparities in neighborhoods that correspond with historical patterns of racial segregation and economic disadvantage.
Perspective:
Understanding the rates of hypertension and treatment patterns in association with where the patient lives is important to reducing disparity of care. Untreated hypertension can lead to chronic disease and be detrimental on cardiovascular health, thereby contributing to poor quality of life. Historically segregated areas in the US have contributed to gaps in the diagnosis and treatment of hypertension. Spatial analysis, as demonstrated in this study, can be used to identify and implement place-based interventions, such as hypertension screenings at local community barbershops and salons, to help reduce these disparities.
Clinical Topics: Prevention, Hypertension, Cardiovascular Care Team
Keywords: Healthcare Disparities, Hypertension, Race Factors
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