Intersection of Social Vulnerability, Social Drivers, and Race on Hypertension Control

Abstract

Background: Hypertension is a leading contributor to morbidity and mortality, disproportionately affecting vulnerable populations. We examined the intersection of social vulnerability and race on blood pressure (BP) control.

Methods: We examined 76,600 patients with hypertension in Western New York State. BP control was defined according to the Healthcare Effectiveness Data and Information Set (HEDIS) as BP<140/90 mmHg. We utilized social vulnerability index (SVI) scores based on each patient's census tract. Log-binomial regression was used to estimate the independent effects of demographic characteristics on the prevalence of uncontrolled blood pressure. Models were adjusted for race, SVI group, age, sex, marital status, and community type. For a convenience subset of patients, we also assessed patient-reported health-related social needs.

Results: Uncontrolled blood pressure among patients differed by race (White 27.7%; Black 41.3%) and increasing social vulnerability. The adjusted risk ratio (aRR) for uncontrolled BP in Black vs White patients by SVI group was SVI 0-24: 1.08 (CI 0.98-1.18); SVI 25-49: 1.30 (CI 1.22-1.38); SVI 50-74: 1.35 (CI 1.27-1.43); and SVI 75-100: 1.25 (CI 1.18-1.32). Black patients reporting food insecurity had a higher prevalence of uncontrolled BP than White patients with similar food insecurity (Black 39.2%; White 28.1%). Similar disparities were seen with housing insecurity (Black 42.3%; White 29.8%); and unmet transportation needs (46.3% Black; 30.0% White).

Conclusions: The impact of increased social vulnerability was experienced disproportionately by Black patients. Among patients living in the most socially vulnerable census tracts, Black patients had 25-35% increased risk of uncontrolled blood pressure compared to White patients.

Keywords: Hypertension; health disparity; health-related social needs; race; social determinants of health; social vulnerability.