Angier H1, Green Bb2, Fankhauser K3, Marino M4, Huguet N3, Larson A5, DeVoe Je3. 1. Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States. Electronic address: angierh@ohsu.edu. 2. Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98110, United States. 3. Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States. 4. Biostatistics Group, Oregon Health & Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States. 5. Research Department, OCHIN Inc, 1881 SW Naito Pkwy, Portland, OR, 97201, United States.
Abstract
OBJECTIVES: To understand if neighborhood-level social deprivation moderates the association between gaining health insurance and improved hypertension control. METHODS: We used electronic health record (EHR) data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) clinical data research network from five states that expanded Medicaid eligibility (CA, OH, OR, WA, WI). We include patients with hypertension aged 19-64. Controlled hypertension was assessed for four groups pre-(1/1/2012-12/31/2013) to post-(1/1/2014-12/31/2017) Affordable Care Act (ACA) Medicaid expansion: (1) newly insured, (2) continuously insured, (3) discontinuously insured, and (4) continuously uninsured. We also used Social Deprivation Index score to derive predicted probability of controlled hypertension using logistic mixed effects. RESULTS: N = 28,485 patients. All groups experienced improved hypertension control: the newly insured saw a greater increase than the other groups (8.6% vs. 0.9% for the continuously uninsured, 1.3% for the continuously and 3.0% for the discontinuously insured). The likelihood of hypertension control rose more for the newly insured (vs. the other insurance groups) for patients living in the most deprived neighborhoods (16% from pre- to post-ACA). CONCLUSIONS: Gaining health insurance was related to hypertension control; individuals living in the most disadvantaged communities experienced the greatest benefit. POLICY IMPLICATIONS: Ensuring health insurance access is important for cardiovascular health, especially among disadvantaged communities.
OBJECTIVES: To understand if neighborhood-level social deprivation moderates the association between gaining health insurance and improved hypertension control. METHODS: We used electronic health record (EHR) data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) clinical data research network from five states that expanded Medicaid eligibility (CA, OH, OR, WA, WI). We include patients with hypertension aged 19-64. Controlled hypertension was assessed for four groups pre-(1/1/2012-12/31/2013) to post-(1/1/2014-12/31/2017) Affordable Care Act (ACA) Medicaid expansion: (1) newly insured, (2) continuously insured, (3) discontinuously insured, and (4) continuously uninsured. We also used Social Deprivation Index score to derive predicted probability of controlled hypertension using logistic mixed effects. RESULTS: N = 28,485 patients. All groups experienced improved hypertension control: the newly insured saw a greater increase than the other groups (8.6% vs. 0.9% for the continuously uninsured, 1.3% for the continuously and 3.0% for the discontinuously insured). The likelihood of hypertension control rose more for the newly insured (vs. the other insurance groups) for patients living in the most deprived neighborhoods (16% from pre- to post-ACA). CONCLUSIONS: Gaining health insurance was related to hypertension control; individuals living in the most disadvantaged communities experienced the greatest benefit. POLICY IMPLICATIONS: Ensuring health insurance access is important for cardiovascular health, especially among disadvantaged communities.
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