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Universal health coverage may reduce imbalances in hypertension management
A shift toward global universal health coverage may facilitate more equitable treatment of chronic conditions such as hypertension, according to recent study results.
Researchers assessed the standards for and discrepancies in hypertension management according to socioeconomic position in the United States and in England, which has universal health care. The researchers utilized data from the Health and Retirement Survey in the United States and the English Longitudinal Study for Aging in England. Participants were grouped by age and socioeconomic status, and the researchers controlled for differences in ethnicity by restricting analysis to non-Hispanic whites. The population included non-Hispanic white respondents aged 50 to 64 years (US market-based vs. English National Health Service [NHS]) and older than 65 years (US Medicare vs. NHS) with a diagnosis of hypertension. Education level, household income and wealth were used to gauge socioeconomic position.
Controlled hypertension was defined as BP lower than 140 mm Hg/90 mm Hg, and the investigators evaluated the prescribing of BP drugs based on respondents’ self-report. Additionally, the researchers evaluated controlled BP in both countries according to the United Kingdom’s audit target of 150 mm Hg/90 mm Hg.
The researchers found no significant differences between countries in cumulative attainment of clinical BP targets in the younger group (62.3% for US market-based vs. 61.3% for NHS; P=.835). However, Americans in the highest wealth brackets had significantly better BP control for the clinical target than those in the English cohort (71.7% vs. 60.9%; P= .037). There were discrepancies according to wealth in terms of both clinical and audit targets in the United States, with those in the wealthier portion of the population more likely to achieve the target BP in the group aged 50 to 64 years (clinical target achieved by 71.7% of wealthy responders vs. 55.2% of poor responders; P=.003). Although this disparity was reduced among US Medicare beneficiaries, it was not entirely eradicated. No difference according to socioeconomic status was observed in English responders (clinical target achieved by 60.9% of wealthy patients vs. 63.5% of poorer patients in those aged 65 years and older; P=.588).
“Unlike disparities in disease prevalence which appear influenced by, amongst other things, wider redistributive social policy and the prevalence of disease risk factors, our findings suggest disparities in hypertension control may be more closely linked to health system structure, notably access to care through insurance,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.