The association of area deprivation index and blood pressure control and therapeutic inertia among older adults with hypertension

Abstract

Neighborhood characteristics may influence patient and clinician management of blood pressure (BP) control. This study examined the association of the Area Deprivation Index (ADI) with uncontrolled BP ( ≥ 140/90 mmHg) at primary care visits and therapeutic inertia (TI) during visits with uncontrolled BP. Data included 52 750 visits among 8 434 patients aged ≥65 years across nine outpatient clinics in Chicago suburbs between January 1, 2017, and March 10, 2020. ADI represents national percentiles of census block group deprivation (0 = least, 100 = most deprived). TI was defined as no initiation or escalation of BP-lowering medication during visits with uncontrolled BP. Adjusted prevalence ratios (PRs) of uncontrolled BP and TI by ADI quartiles were estimated using generalized estimating equations. Mean age was 74.3 years (SD 7.8), 42.3% were male, 69.1% Non-Hispanic (NH) White, 15.9% NH Black, and 8.2% Hispanic. Uncontrolled BP occurred in 33.8% of visits. Of those, 73.4% experienced TI. There was no significant association between ADI and uncontrolled BP in adjusted models. Adjusted PRs of TI were higher in ADI Q2 (PR 1.03, 95% CI: 1.00-1.06) and Q3 (PR 1.04 (95% CI: 1.01-1.07), but not Q4 compared to Q1. ADI modeled continuously with splines showed modest increases in adjusted predicted prevalence of both outcomes, although confidence intervals widened at the extremes. Neighborhood deprivation may contribute to disparities in hypertension management but more studies with larger number of patient visits at the extremes of ADI distribution are needed.