Abstract Body (Do not enter title and authors here): Blood pressure (BP) control among older adults may differ by neighborhood due to differences in access to healthy foods, safe places to exercise, and stress. Neighborhood disadvantage may also influence clinician behaviors for hypertension management.
This retrospective observational study utilized electronic health data from 52,750 primary care visits among 8,434 adults age ≥ 65 years with hypertension between January 1, 2017, and March 10, 2020 to examine the association of Area Deprivation Index (ADI) with odds of uncontrolled BP during a clinic visit and with therapeutic inertia (TI). Higher ADI values indicate higher deprivation. TI was defined as the absence of a prescription for or escalation of a new BP lowering medication during clinic visits with systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. Binary generalized linear mixed models were used to determine the association of ADI quartiles with uncontrolled BP and with TI during a clinic visit while adjusting for demographics, comorbidities, insurance status, and the intra-patient correlation. Among the 8,434 patients, the mean age at the first visit was 74.3 years (standard deviation 7.8), 57.7% were female, and race/ethnicity was self-reported as non-Hispanic (NH) White in 69.1%, NH Black in 15.9%, NH Other in 5.0%, and Hispanic in 8.2%. The median ADI was 41 (interquartile range: 26-53). The percentage of clinic visits with uncontrolled BP ranged from 39.1% in the first to 44.1% in the fourth ADI quartile.
Figure 1 shows the unadjusted and adjusted odds of uncontrolled BP and TI by ADI quartiles. Adjusted odds of uncontrolled BP during a clinic visit was 1.17 (95% confidence interval (CI) 1.06, 1.28) in the fourth vs. first ADI quartile. Among the 21,928 clinic visits with uncontrolled BP, TI occurred in 79.5%, 82.2%, 83.0%, and 81.6% of visits in ADI quartiles one, two, three, and four, respectively. Adjusted odds of TI during a clinic visit was 1.16 (95% CI 1.01, 1.33) in the fourth vs. first ADI quartile.
Our findings of higher odds of uncontrolled BP and TI during clinic visits with patients residing in neighborhoods with higher vs. lower ADI suggest that neighborhood disadvantage is associated with both uncontrolled BP and TI in older adults.