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Latino-White Disparities in Identification and Control of Elevated Blood Pressure Among Adults With Hypertension
David Boston1, Jun Hwang2, Jennifer A Lucas2
1OCHIN Inc. Portland OR USA.
Insights
This study found no disparities in hypertension management between Latino and White patients in community health centers. Findings suggest community health centers may be effectively reducing hypertension care gaps.
Area of Science:
- Public Health
- Cardiology
- Health Disparities Research
Background:
- Hypertension control cascade studies reveal significant disparities in awareness, treatment, and control between Latino and non-Latino White patients.
- Existing research highlights gaps in hypertension management across different racial and ethnic groups.
Purpose of the Study:
- To analyze the hypertension control cascade using electronic health record data from a multistate network of community health centers.
- To compare hypertension awareness, treatment, and control between Latino and non-Latino White patients within community health center settings.
Main Methods:
- Retrospective analysis of electronic health record data from 790 clinics across 23 US states (2012-2020).
- Inclusion of 1,270,174 patients, comparing blood pressure (BP) documentation, clinician acknowledgment of hypertension, medication prescription, and BP control.
- Adjusted analysis for patient-level covariates and clustered by primary clinics.
Main Results:
- Among 429,182 patients with elevated BP (≥140/90), clinician acknowledgment of hypertension was more likely in Spanish-preferring and English-preferring Latino patients compared to non-Latino White patients.
- Spanish-preferring Latino patients were more likely to receive hypertension medication than non-Latino White patients.
- No significant differences in BP control (<140/90) were observed among patients receiving medication, regardless of ethnicity.
Conclusions:
- Contrary to expectations, this study did not identify disparities in hypertension management between Latino and non-Latino White patients in community health centers.
- These findings, based on robust electronic health record data, suggest community health centers may be mitigating expected hypertension care gaps.
- The study provides valuable insights into potential strategies for reducing hypertension management disparities.
Background:
Studies analyzing blood pressure (BP) management using the hypertension control cascade have consistently shown disparities in hypertension awareness, treatment, and BP control between Latino patients and non-Latino White patients. We analyze this cascade using electronic health record data from a multistate network of community health centers.
Methods And Results:
Data from 790 clinics in 23 US states from 2012 to 2020, including 1 270 174 patients, were analyzed to compare BP documentation in the electronic health record, clinician acknowledgment (diagnosis or treatment) of incident hypertension (BP ≥140/90), medication prescription, and BP control between non-Latino White patients, English-preferring Latino patients, and Spanish-preferring Latino patients, adjusted for patient-level covariates, and clustered on patients' primary clinics. Among the 429 182 patients with elevated BP (≥140/90) during ambulatory visits from 2012 to 2020, we found that clinician acknowledgment of hypertension was more likely in Spanish-preferring and English-preferring Latino patients versus non-Latino White patients (adjusted odds ratio [aOR], 1.17 [95% CI, 1.11-1.24]; aOR, 1.07 [95% CI, 1.02-1.12], respectively). In addition, Spanish-preferring Latino patients were more likely to receive a medication versus non-Latino White patients (aOR, 1.21 [95% CI, 1.16-1.28]). Among those receiving medication, Latino patients were as likely as non-Latino White patients to have their BP controlled (<140/90).
Conclusions:
In a large retrospective study of community health center patients with incident hypertension, the expected disparities in hypertension management between Spanish-preferring Latino, English-preferring Latino, and non-Latino White patients were not identified. These findings add to the hypertension control cascade by examining robust electronic health record data from community health centers and may provide clues to reducing disparities in hypertension management.
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