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Health insurance expansion may improve hypertension treatment
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Health insurance expansions under the Affordable Care Act could increase the rate of hypertension treatment by 5.1%, preventing approximately 174,000 to 408,000 new cases of CHD and stroke by 2050, according to a recent report published in Preventing Chronic Disease.
Furthermore, expanding health insurance has the potential to save 2,568 to 6,000 lives and $1.2 billion to $2.8 billion in medical costs per year, according to Suhui Li, PhD, from the department of health policy and management of the Milken Institute School of Public Health at George Washington University, and colleagues.
Li and colleagues estimated the long-term effects of expanding health insurance for 55 million nonelderly adults with hypertension. They used a state-transition model stratified for age and sex to predict the probability of death each year based on age, insurance status and history of MI, angina and/or stroke. Two expansion scenarios were assessed in the report: health insurance expanded to some states and health insurance expanded to all states.
In the first scenario, the researchers presumed that any states currently undecided on expanding health insurance would opt out of increasing Medicaid coverage. In this model, the number of hypertensive patients treated with antihypertensive medications increased from 56.7% to 59.5%. Subsequently, the model predicted that by 2050, the incidence of new CHD events would decrease by 111,000 (0.55%), new stroke events would decrease by 63,000 (0.75%) and CVD-related moralities by 95,000 (1.16%).
The projected increase in treatment rates was greater among patients aged 25 to 34 years compared with patients aged 55 to 64 years (9.4% vs. 3.4%), which led to fewer mortalities in the younger population (1.2% to 3.2%). The expansions were more beneficial for men than women because current treatment rates are significantly lower in men, according to the researchers.
The model also predicted that fewer incidences of CHD, stroke and CVD-related mortality would occur in the white population. However, the Hispanic population demonstrated greater reductions to CHD (2.07% vs. 0.51%), stroke (1.06% vs. 0.5%) and CV-related mortality rates (3.84% vs. 1.19%) compared with whites.
“Blacks would also receive proportionally larger benefits than whites because they have the highest rates of hypertension, as well as other CVD risk factors, such as diabetes and obesity,” Li and colleagues wrote.
In the second scenario, the researchers considered the effects of expanding health insurance to all patients currently uninsured. As a result, the number of patients receiving antihypertensive treatment would increase to 63.5% and CHD events would decrease by 1.48%, stroke events by 1.3% and CVD-related mortalities by 2.73%. Similar to the first scenario, mortality benefits were stronger in the younger (2.4% to 9.4%) and nonwhite populations.
A sensitivity analysis was conducted in both scenarios to test the health effects of continuous insurance coverage over time. The outcomes projected even greater improvements in CHD (307,000 to 485,000 fewer cases), stroke (138,000 to 266,000 fewer cases) and CVD-related mortality rates (217,000 to 513,000 fewer cases).
The researchers also incorporated 53 million patients with prehypertension into the model and found that increased access to early interventions would further reduce cases of CHD by 253,000 to 535,000; stroke by 77,000 to 189,000; and mortality by 165,000 to 364,000.
“This study demonstrates that improved hypertension treatment through the expansion of health insurance coverage would yield substantial health benefits for the 55 million nonelderly hypertensive adults in the United States,” the researchers concluded. – by Stephanie Viguers
Disclosure: The study was supported by the American Heart Association.
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