Hypertension prevalence in the All of Us Research Program among groups traditionally underrepresented in medical research

Abstract

The All of Us Research Program was designed to enable broad-based precision medicine research in a cohort of unprecedented scale and diversity. Hypertension (HTN) is a major public health concern. The validity of HTN data and definition of hypertension cases in the All of Us (AoU) Research Program for use in rule-based algorithms is unknown. In this cross-sectional, population-based study, we compare HTN prevalence in the AoU Research Program to HTN prevalence in the 2015-2016 National Health and Nutrition Examination Survey (NHANES). We used AoU baseline data from patient (age ≥ 18) measurements (PM), surveys, and electronic health record (EHR) blood pressure measurements. We retrospectively examined the prevalence of HTN in the EHR cohort using Systemized Nomenclature of Medicine (SNOMED) codes and blood pressure medications recorded in the EHR. We defined HTN as the participant having at least 2 HTN diagnosis/billing codes on separate dates in the EHR data AND at least one HTN medication. We calculated an age-standardized HTN prevalence according to the age distribution of the U.S. Census, using 3 groups (18-39, 40-59, and ≥ 60). Among the 185,770 participants enrolled in the AoU Cohort (mean age at enrollment = 51.2 years) available in a Researcher Workbench as of October 2019, EHR data was available for at least one SNOMED code from 112,805 participants, medications for 104,230 participants, and 103,490 participants had both medication and SNOMED data. The total number of persons with SNOMED codes on at least two distinct dates and at least one antihypertensive medication was 33,310 for a crude prevalence of HTN of 32.2%. AoU age-adjusted HTN prevalence was 27.9% using 3 groups compared to 29.6% in NHANES. The AoU cohort is a growing source of diverse longitudinal data to study hypertension nationwide and develop precision rule-based algorithms for use in hypertension treatment and prevention research. The prevalence of hypertension in this cohort is similar to that in prior population-based surveys.

Figure 1

Prevalence of HTN among adults aged 18 and over, by age: All of Us, 2018–2019; ages 18 and over (blue), 18 to 39 (red), 40 to 59 (green), and 60 and over (purple) years. All estimates are age adjusted using the census population size at each age group as of July 1, 2018, based on https://www.census.gov/newsroom/press-kits/2019/detailed-estimates.html. Error bars show 95% confidence intervals for HTN prevalence estimates. Figure was created with Microsoft Excel for Mac, Version 16.46.

Figure 2

Prevalence of HTN among adults aged 18 and over, by age: United States, 2015–2016; ages 18 and over (blue), 18 to 39 (red), 40 to 59 (green), and 60 and over (purple) years. All estimates are age adjusted by the direct method using computed weights based on the subpopulation of persons with HTN in the 2007–2008 National Health and Nutrition Examination Survey, using age groups 18–39, 40–59, and 60 and over. Access data table for Fig. 2 at: https://www.cdc.gov/nchs/data/databriefs/db289_table.pdf#4. SOURCE: NCHS, National Health and Nutrition Examination Survey, 2015–2016. Figure was created with Microsoft Excel for Mac, Version 16.46.

Figure 3

Crude HTN prevalence by SES in All of Us, 2018–2019. Error bars show 95% confidence intervals for HTN prevalence estimates. U.S. Census data is not available for age-distribution by SES categories. Figure was created with Microsoft Excel for Mac, Version 16.46.

Figure 4

Crude HTN prevalence in All of Us by geographic region, 2018–2019. Error bars show 95% confidence intervals for HTN prevalence estimates. U.S. Census data is not available for age-distribution by geographic region. Figure was created with Microsoft Excel for Mac, Version 16.46.