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Published on: January 12, 2018
Association of Hypertension With Health Care Access and Utilization Following Childbirth: Differences by Race and
Laura B Attanasio1, Linnea Evans1, Lara Kovell2
1University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts, USA.
Background:
Hypertensive disorders of pregnancy raise long-term cardiovascular risk, but little is known about health care access and preventive utilization in the years postpartum.
Objectives:
The objective of the study was to examine health care access and utilization in the 5 years following childbirth by hypertension status and race and ethnicity.
Methods:
We conducted a cross-sectional analysis of 2021 and 2023 Behavioral Risk Factor Surveillance System data. We included women with 1 child under age 5. Exposure categories were no hypertension, pregnancy-only hypertension, and hypertension. Outcomes were having a personal health care provider, foregoing care due to affordability in the past year, past-year checkup, and past-year cholesterol test. We used multivariable logistic regression, adding interaction terms to assess variation by race and ethnicity.
Results:
The analytic sample represented a weighted population of 3,175,662. Compared with no hypertension, individuals with hypertension had a 9.0 percentage-point (pp) higher predicted probability of having a personal doctor (95% CI: 2.9-15.2 pp) and a 19.8 pp higher probability of a past-year cholesterol check (95% CI: 9.8-29.8 pp). Pregnancy-only hypertension did not differ from no hypertension for any outcome. In models with interaction terms, hypertension (vs no hypertension) was associated with a higher probability of having a personal doctor and past-year cholesterol for White and Black respondents but not for Hispanic respondents. Hypertension was associated with higher probability of past-year checkup among White women only.
Conclusions:
Pregnancy-only hypertension was not linked to increased preventive care utilization, indicating missed opportunities to connect people with hypertensive disorders of pregnancy history to sustained cardiovascular disease prevention.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.