Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018
Background Hypertension is an important modifiable risk factor of serious maternal morbidity and mortality. Social determinants of health (SDoH) influence hypertension outcomes and may contribute to racial and ethnic differences in hypertension control. Our objective was to assess SDoH and blood pre...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027169 |
| _version_ | 1797290429077520384 |
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| author | Claire V. Meyerovitz Stephen P. Juraschek Didem Ayturk Tiffany A. Moore Simas Sharina D. Person Stephenie C. Lemon David D. McManus Lara C. Kovell |
| author_facet | Claire V. Meyerovitz Stephen P. Juraschek Didem Ayturk Tiffany A. Moore Simas Sharina D. Person Stephenie C. Lemon David D. McManus Lara C. Kovell |
| author_sort | Claire V. Meyerovitz |
| collection | DOAJ |
| description | Background Hypertension is an important modifiable risk factor of serious maternal morbidity and mortality. Social determinants of health (SDoH) influence hypertension outcomes and may contribute to racial and ethnic differences in hypertension control. Our objective was to assess SDoH and blood pressure (BP) control by race and ethnicity in US women of childbearing age with hypertension. Methods and Results We studied women (aged 20–50 years) with hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or use of antihypertensive medication) in the National Health and Nutrition Examination Surveys 2001 to 2018. SDoH and BP control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) were examined by race and ethnicity (White race, Black race, Hispanic ethnicity, and Asian race). Using multivariable logistic regression, odds of uncontrolled BP by race and ethnicity were modeled, adjusting for SDoH, health factors, and modifiable health behaviors. Responses on hunger and affording food determined food insecurity status. Across women of childbearing age with hypertension (N=1293), 59.2% were White race, 23.4% were Black race, 15.8% were Hispanic ethnicity, and 1.7% were Asian race. More Hispanic and Black women experienced food insecurity than White women (32% and 25% versus 13%; both P<0.001). After SDoH, health factor, and modifiable health behavior adjustment, Black women maintained higher odds of uncontrolled BP than White women (odds ratio, 2.31 [95% CI, 1.08–4.92]), whereas Asian and Hispanic women showed no difference. Conclusions We identified racial inequities in uncontrolled BP and food insecurity among women of childbearing age with hypertension. Further exploration beyond the SDoH measured is needed to understand the inequity in hypertension control in Black women. |
| first_indexed | 2024-03-07T19:22:16Z |
| format | Article |
| id | doaj.art-c60be9760a65419bb185c33223114e24 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T19:22:16Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c60be9760a65419bb185c33223114e242024-02-29T10:25:12ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-03-0112510.1161/JAHA.122.027169Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018Claire V. Meyerovitz0Stephen P. Juraschek1Didem Ayturk2Tiffany A. Moore Simas3Sharina D. Person4Stephenie C. Lemon5David D. McManus6Lara C. Kovell7UMass Chan Medical School Worcester MADivision of General Medicine Beth Israel Deaconess Medical Center/Harvard Medical School Boston MADepartment of Population and Quantitative Health Sciences UMass Chan Medical School Worcester MADepartment of Population and Quantitative Health Sciences UMass Chan Medical School Worcester MADepartment of Population and Quantitative Health Sciences UMass Chan Medical School Worcester MADepartment of Population and Quantitative Health Sciences UMass Chan Medical School Worcester MADivision of Cardiovascular Medicine, Department of Medicine UMass Chan Medical School Worcester MADivision of Cardiovascular Medicine, Department of Medicine UMass Chan Medical School Worcester MABackground Hypertension is an important modifiable risk factor of serious maternal morbidity and mortality. Social determinants of health (SDoH) influence hypertension outcomes and may contribute to racial and ethnic differences in hypertension control. Our objective was to assess SDoH and blood pressure (BP) control by race and ethnicity in US women of childbearing age with hypertension. Methods and Results We studied women (aged 20–50 years) with hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or use of antihypertensive medication) in the National Health and Nutrition Examination Surveys 2001 to 2018. SDoH and BP control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) were examined by race and ethnicity (White race, Black race, Hispanic ethnicity, and Asian race). Using multivariable logistic regression, odds of uncontrolled BP by race and ethnicity were modeled, adjusting for SDoH, health factors, and modifiable health behaviors. Responses on hunger and affording food determined food insecurity status. Across women of childbearing age with hypertension (N=1293), 59.2% were White race, 23.4% were Black race, 15.8% were Hispanic ethnicity, and 1.7% were Asian race. More Hispanic and Black women experienced food insecurity than White women (32% and 25% versus 13%; both P<0.001). After SDoH, health factor, and modifiable health behavior adjustment, Black women maintained higher odds of uncontrolled BP than White women (odds ratio, 2.31 [95% CI, 1.08–4.92]), whereas Asian and Hispanic women showed no difference. Conclusions We identified racial inequities in uncontrolled BP and food insecurity among women of childbearing age with hypertension. Further exploration beyond the SDoH measured is needed to understand the inequity in hypertension control in Black women.https://www.ahajournals.org/doi/10.1161/JAHA.122.027169disparityequityhypertensionracereproductive healthwomen |
| spellingShingle | Claire V. Meyerovitz Stephen P. Juraschek Didem Ayturk Tiffany A. Moore Simas Sharina D. Person Stephenie C. Lemon David D. McManus Lara C. Kovell Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease disparity equity hypertension race reproductive health women |
| title | Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018 |
| title_full | Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018 |
| title_fullStr | Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018 |
| title_full_unstemmed | Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018 |
| title_short | Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018 |
| title_sort | social determinants blood pressure control and racial inequities in childbearing age women with hypertension 2001 to 2018 |
| topic | disparity equity hypertension race reproductive health women |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027169 |
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