Abstract Body: Background: Rural populations face multiple challenges related to social determinants of health (SDOH). However, the extent of these disparities between rural and non-rural residing people with elevated blood pressure or untreated stage 1 hypertension is not well described. Further understanding of these disparities in the context of a hypertension prevention program focused on addressing SDOH that may contribute to the development of hypertension may inform targeted interventions.
Objective: To examine differences in SDOH between rural and non-rural residents with elevated blood pressure or untreated stage 1 hypertension and identify areas for targeted interventions within the context of a blood pressure management program.
Methods: This cross-sectional study analyzed baseline data from the LINKED-BP (Home Blood Pressure Telemonitoring Linked with Community Health Workers to Improve Blood Pressure) Program. SDOH were assessed using standardized questionnaires covering education, income, housing, food security, transportation, utilities, and social support. Rurality was determined based on zip code. Chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables were used for comparisons between rural and non-rural groups.
Results: The study included 308 adults (127 rural, 181 non-rural) with known ZIP codes. People residing in rural areas had lower educational attainment (25.2% vs 1.1% with less than high school education, P<0.001) and lower income (40.2% vs 6.1% earning ≤$39,999 annually, P<0.001) compared to non-rural residents. Food insecurity (24.4% vs 5.0%, P<0.001) and transportation needs (19.7% vs 3.9%, P<0.001) were more prevalent in rural areas. Housing insecurity was higher in rural areas but was not statistically significant (5.5% vs 1.7%, P=0.060). No differences were found in housing conditions, utility needs, or social/emotional support.
Conclusions: Significant SDOH disparities exist between rural and non-rural populations particularly in education, income, food security, and transportation access. These findings highlight potential challenges in implementing home blood pressure telemonitoring programs in rural areas. Targeted interventions addressing these SDOH factors could enhance the effectiveness of blood pressure management programs in rural communities. Future research should explore whether proactively addressing SDOH disparities in rural communities prevents hypertension and cardiovascular disease.