Good access to primary care may improve community level hypertension control, awareness
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Communities with better access to primary care had better hypertension prevalence, control and awareness compared with communities with worse access, researchers reported.
“Access to primary care is the key to hypertension management; however, many Americans have limited access to primary care where they live,” Brisa Aschebrook-Kilfoy, PhD, associate professor of public health sciences at the University of Chicago, said in a press release. “This is especially true of people in economically disadvantaged neighborhoods or people from diverse racial and ethnic groups, particularly among African American individuals.”
For this study, researchers included 5,096 participants from COMPASS and evaluated the association between spatial accessibility to primary care and hypertension status in low-income areas of Chicago. Black individuals represented 84% of the overall cohort and more than 53% of participants reported annual household income of less than $15,000 (mean age, 53 years; 37% overweight/obese).
Hypertension, defined as systolic BP of at least 130 mm Hg or diastolic BP of at least 80 mm Hg, was observed in 78.7% of participants, of whom 37.7% had uncontrolled hypertension and 41% were unaware they had hypertension.
To develop a score for spatial accessibility of primary care, participants’ homes were geocoded, and locations of primary care physicians in Chicago were obtained from MAPSCorps. The researchers used an enhanced two-step floating catchment area method to create an accessibility score, with a higher score indicating better accessibility.
Primary care accessibility and hypertension prevalence
Compared with the lowest quartile of primary care accessibility scores, the OR for hypertension in the community strengthened in every other quartile as accessibility score increased (P for trend < .01):
- second quartile (OR = 0.82; 95% CI, 0.67-1.01);
- third quartile (OR = 0.75; 95% CI, 0.62-0.91); and
- fourth and highest quartile (OR = 0.73; 95% CI, 0.6-0.89; P for trend < .01).
Researchers reported similar trends for the prevalence of uncontrolled and unaware hypertension; a higher accessibility score was associated with a lower rate of unaware hypertension, regardless of neighborhood socioeconomic status.
Higher accessibility score was also associated with lower prevalence of uncontrolled hypertension in neighborhoods with lower socioeconomic status (OR = 0.68; 95% CI, 0.52-0.88), and not in neighborhoods with better socioeconomic status (OR = 0.67; 95% CI, 0.35-1.31), but the differences were not statistically significant.
“When stratified by neighborhood socioeconomic status, the association with unaware hypertension was observed in both disadvantaged and nondisadvantaged neighborhoods, whereas the association with uncontrolled hypertension was still observed in disadvantaged neighborhoods,” the researchers wrote. “These findings suggest that ensuring adequate number of primary care providers can be effective to improve population health. Residents in disadvantaged neighborhoods can also benefit from interventions that increase the number of primary physicians.”
Investing to improve CV health
In a related editorial, Kiarri N. Kershaw, PhD, MPH, associate professor of preventive medicine, and Sadiya S. Khan, MD, MSc, FACC, FAHA, assistant professor of medicine and preventive medicine, associate program director of the cardiovascular disease fellowship and director of research in the section of heart failure at Northwestern University Feinberg School of Medicine, discussed how investing in communities with poor access to primary care could improve community-level CV health.
“Increasing spatial access to primary care is one of many investments that could improve cardiovascular health and health equity,” they wrote. “Adding resources like supermarkets makes it easier for people engage in healthful behaviors while also providing jobs and stimulating the local economy. Investing in parks and safe places to play and socialize promotes physical activity and social cohesion. Eliminating inequities in hypertension control will require multilevel, multicomponent interventions that target the multitude of individual, health system and structural barriers to equitably optimize cardiovascular health in under-resourced communities at greatest risk.”
References:
- High blood pressure awareness, control improved with better access to primary health care. newsroom.heart.org/news/high-blood-pressure-awareness-control-improved-with-better-access-to-primary-health-care. Accessed Sep. 6, 2022. Published Sep. 6, 2022.
- Kershaw KN, et al. Circ Cardiovasc Qual Outcomes. 2022;doi:10.1161/CIRCOUTCOMES.122.009374.
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