Area deprivation tied to youth hypertension in Medicaid recipients
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Key takeaways:
- Youths with a worse area deprivation index score were more likely to have hypertension than those with a better one.
- Identifying neighborhood-level risk factors could help improve long-term CV outcomes.
Among Medicaid-insured youths from Delaware, higher childhood neighborhood area deprivation index score was associated with hypertension diagnosis, researchers reported.
“Improving cardiovascular health means understanding what contributes to risk factors for cardiovascular disease when it begins in childhood. Hypertension is a primary risk factor for heart disease. In this study, we wanted to explore the relationship between a composite of the neighborhood-level deprivation (eg, education levels, income, housing, etc) and hypertension in children,” Carissa M. Baker-Smith, MD, MPH, director of pediatric preventive cardiology, Nemours Children’s Health, Delaware Valley, told Healio. “Factors contributing to hypertension development in children and adolescents are not solely individual or family-level factors but also include neighborhood-level factors.”
Baker-Smith and colleagues analyzed 65,452 youths from Delaware who received Medicaid insurance between 2014 and 2019 and were stratified by national area deprivation index (ADI), registered as a score of 1 to 100, with 100 being the areas with the most deprivation.
“This study assessed the relationship between degree of community-level deprivation and hypertension diagnosis in youth,” Baker-Smith told Healio. “There are three steps required: the development of blood pressure in the child that meets the criteria for a diagnosis of hypertension, the recognition of the blood pressure as high by the clinical provider/physician, and the entering of this diagnosis into the patient’s chart. Higher deprivation according to the ADI is defined by the education level, income/employment, housing quality and household characteristics of persons within the community.”
Primary hypertension in youths
Among the cohort, 1.7% had a diagnosis of primary hypertension (mean age, 13.3 years; 41% female; 24% Hispanic; 40% Black; 62% with obesity; 54% with ADI 50 or more) and the rest did not (47% female; 19% Hispanic; 40% Black; 20% with obesity; 49% with ADI 50).
In a multivariable logistic regression analysis, residence in a community with an ADI of 50 or more was associated with increased odds of a hypertension diagnosis (OR = 1.61; 95% CI, 1.04-2.51), Baker-Smith and colleagues found.
In addition, older age (OR per year = 1.16; 95% CI, 1.14-1.18), obesity diagnosis (OR = 5.16; 95% CI, 4.54-5.85) and longer duration of full Medicaid benefit coverage (OR = 1.03; 95% CI, 1.03-1.04) were associated with greater odds of a primary hypertension diagnosis, whereas female sex (OR = 0.68; 95% CI, 0.61-0.77) was associated with lower odds of one, according to the researchers.
There was no relationship between race/ethnicity and hypertension diagnosis.
Modifiable risk factor
“Our study demonstrates an association between community-level education, income/employment, housing, and housing quality and hypertension diagnosis in children and adolescents,” Baker-Smith told Healio.
She said the researchers are conducting further analyses to determine if the results are generalizable to the U.S. as a whole, and the data so far indicate that they are.
“My goal in conducting this study was to highlight a potentially modifiable factor associated with cardiovascular disease risk factor development in children and to highlight that some of these risks extend beyond a child’s individual factors or those of their families,” Baker-Smith told Healio. “Identifying associations between disease and potentially modifiable factors, vs. focusing on factors that we cannot change, offers an expanded opportunity for devising strategies that have the potential to improve long-term CV outcomes.”
For more information:
Carissa M. Baker-Smith, MD, MPH, can be reached at carissa.baker-smith@nemours.org.
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