Variation in Hypertension Control by Race and Ethnicity, and Geography in US Veterans
Background Hypertension control and related cardiovascular outcomes among Americans remain suboptimal, and differ by race, ethnicity, and geography. Healthcare access is one of multiple critical factors in hypertension control. Understanding the degree to which healthcare access, versus other factor...
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Wiley
2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.035682 |
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| author | Kimberly E. Lind Michelle S. Wong Stephen E. Frochen Anita H. Yuan Donna L. Washington |
| author_facet | Kimberly E. Lind Michelle S. Wong Stephen E. Frochen Anita H. Yuan Donna L. Washington |
| author_sort | Kimberly E. Lind |
| collection | DOAJ |
| description | Background Hypertension control and related cardiovascular outcomes among Americans remain suboptimal, and differ by race, ethnicity, and geography. Healthcare access is one of multiple critical factors in hypertension control. Understanding the degree to which healthcare access, versus other factors, produce these outcomes can inform policies and interventions to improve cardiovascular outcomes and reduce disparities. Department of Veterans Affairs Healthcare System data provide a unique opportunity to understand residual racial and ethnic differences in hypertension control after accounting for healthcare access. Our objective was to describe pre‐pandemic post‐Affordable Care Act implementation hypertension control by geographic sector and race and ethnicity, and assess spatial clustering of hypertension control. Methods and Results A secondary data analysis of hypertension control among US veterans (n=1 619 414) nationwide and in 4 US territories was conducted using electronic health record data. Age‐ and sex‐adjusted regression models estimated overall and race‐ and ethnicity‐specific rates by geographic sector. We created choropleth maps of hypertension control rates and assessed spatial autocorrelation. Hypertension control rates varied across sectors by race and ethnicity (range, 44.1%–97.5%); Black veterans, followed by American Indian or Alaska Native veterans, had the lowest mean control rates (72.5% and 75.4%, respectively). There was clustering of low hypertension control rates for Black veterans in the Pacific Northwest, Southwest, Missouri, Kansas, and Arkansas, and for American Indian or Alaska Native veterans in the West and Southwest. Conclusions Hypertension control rates varied geographically for veteran groups experiencing racial and ethnic disparities. Geographic areas with concentrations of low rates of hypertension control should be a focus for interventions to address racial and ethnic disparities. |
| format | Article |
| id | doaj-art-8a67068efa8144ef854f39ad08005cde |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-8a67068efa8144ef854f39ad08005cde2025-08-20T03:07:41ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114210.1161/JAHA.123.035682Variation in Hypertension Control by Race and Ethnicity, and Geography in US VeteransKimberly E. Lind0Michelle S. Wong1Stephen E. Frochen2Anita H. Yuan3Donna L. Washington4VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) VA Greater Los Angeles Healthcare System Los Angeles CA USAVA HSR Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) VA Greater Los Angeles Healthcare System Los Angeles CA USAVA HSR Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) VA Greater Los Angeles Healthcare System Los Angeles CA USAVA HSR Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) VA Greater Los Angeles Healthcare System Los Angeles CA USAVA HSR Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP) VA Greater Los Angeles Healthcare System Los Angeles CA USABackground Hypertension control and related cardiovascular outcomes among Americans remain suboptimal, and differ by race, ethnicity, and geography. Healthcare access is one of multiple critical factors in hypertension control. Understanding the degree to which healthcare access, versus other factors, produce these outcomes can inform policies and interventions to improve cardiovascular outcomes and reduce disparities. Department of Veterans Affairs Healthcare System data provide a unique opportunity to understand residual racial and ethnic differences in hypertension control after accounting for healthcare access. Our objective was to describe pre‐pandemic post‐Affordable Care Act implementation hypertension control by geographic sector and race and ethnicity, and assess spatial clustering of hypertension control. Methods and Results A secondary data analysis of hypertension control among US veterans (n=1 619 414) nationwide and in 4 US territories was conducted using electronic health record data. Age‐ and sex‐adjusted regression models estimated overall and race‐ and ethnicity‐specific rates by geographic sector. We created choropleth maps of hypertension control rates and assessed spatial autocorrelation. Hypertension control rates varied across sectors by race and ethnicity (range, 44.1%–97.5%); Black veterans, followed by American Indian or Alaska Native veterans, had the lowest mean control rates (72.5% and 75.4%, respectively). There was clustering of low hypertension control rates for Black veterans in the Pacific Northwest, Southwest, Missouri, Kansas, and Arkansas, and for American Indian or Alaska Native veterans in the West and Southwest. Conclusions Hypertension control rates varied geographically for veteran groups experiencing racial and ethnic disparities. Geographic areas with concentrations of low rates of hypertension control should be a focus for interventions to address racial and ethnic disparities.https://www.ahajournals.org/doi/10.1161/JAHA.123.035682disparitieshealth equityhypertensionsecondary prevention |
| spellingShingle | Kimberly E. Lind Michelle S. Wong Stephen E. Frochen Anita H. Yuan Donna L. Washington Variation in Hypertension Control by Race and Ethnicity, and Geography in US Veterans Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease disparities health equity hypertension secondary prevention |
| title | Variation in Hypertension Control by Race and Ethnicity, and Geography in US Veterans |
| title_full | Variation in Hypertension Control by Race and Ethnicity, and Geography in US Veterans |
| title_fullStr | Variation in Hypertension Control by Race and Ethnicity, and Geography in US Veterans |
| title_full_unstemmed | Variation in Hypertension Control by Race and Ethnicity, and Geography in US Veterans |
| title_short | Variation in Hypertension Control by Race and Ethnicity, and Geography in US Veterans |
| title_sort | variation in hypertension control by race and ethnicity and geography in us veterans |
| topic | disparities health equity hypertension secondary prevention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.035682 |
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