Are demographic characteristics, health care access and utilization, and comorbid conditions associated with hypertension among US adults?

Abstract

Background: Little is known about the factors associated with hypertension awareness, treatment, and control. We examined the association of demographic and socioeconomic characteristics, risk factors, health care access and utilization, and hypertension awareness, treatment, and control.

Methods: The National Health and Nutrition Examination Survey (NHANES) 1999-2004, a continuous, annual survey of the civilian non-institutionalized US population. The sample comprised 4,816 hypertensive persons aged 20+ years.

Results: Adults > or =60 years were more likely to have uncontrolled hypertension compared with adults 40-59 years old (60-69 years old: odds ratio (OR) 1.69, confidence interval (CI) 1.31-2.17; 80+ years old: OR 3.56, CI 2.42-5.25, respectively). Compared to men, women were more likely to have uncontrolled hypertension (OR 1.29, CI 1.01-1.64). When compared with non-Hispanic whites, non-Hispanic blacks were more likely to have uncontrolled hypertension (OR 1.40, CI 1.10-1.79). Diabetes and Poverty Income Ratio (PIR) classification of <1 were associated with increased likelihood of uncontrolled hypertension (OR 2.69, CI 1.99-3.63; OR 1.68, CI 1.19-2.37; respectively). Persons without health insurance had higher odds of being untreated when compared with insured persons (OR 2.38, CI 1.71-3.32). Younger age (20-39 years), lack of risk factors for hypertension and less health care were associated with increased odds of being unaware of hypertension.

Conclusions: Uncontrolled hypertension is more likely among women, older persons (> or =60 years), non-Hispanic blacks, the poor, and diabetics. Hypertension awareness and treatment is lower among the young (20-39 years), the uninsured, individuals reporting fewer health risk factors, and adults with less exposure and utilization of health care.