High Blood Pressure Reduction, Health Insurance Status, and Social Deprivation Index in U.S. Community Health Centers

Introduction: Lack of health insurance is a risk factor for uncontrolled hypertension, but it is unknown whether health insurance or neighborhood-level social deprivation is associated with greater reductions in blood pressure over time. Methods: We estimated the association of health insurance and social deprivation index on blood pressure reduction over time using electronic health record data from 2012 to 2017. We included patients aged 19–64 years with an initial systolic blood pressure ≥150 mmHg or diastolic blood pressure ≥100 mmHg and ≥1 additional visit from 93 community health centers in states that expanded Medicaid in 2014. Results: We included 66,207 patients: 20.1% uninsured, 64.8% publicly insured, and 15.1% privately insured. Adjusting for patient characteristics and baseline blood pressure, systolic blood pressure/diastolic blood pressure declined over the study period by 21.3/11.2 mmHg, 22.0/11.4 mmHg, and 21.1/10.7 mmHg among uninsured, publicly insured, and privately insured individuals, respectively. There were small but significantly greater reductions in systolic blood pressure among patients with public insurance than among those who were uninsured (difference= −1.3, 95% CI= −1.6, −1.0) but none associated with social deprivation index. There were no differences in diastolic blood pressure reductions over time by insurance status or social deprivation index. Blood pressure control (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) was significantly greater among publicly or commercially insured individuals than among uninsured individuals (51.7%, 51.5%, 44.6% respectively, both comparisons p<0.001), with no associations between blood pressure control and social deprivation index. Conclusions: Reductions in blood pressure were large but mostly not associated with insurance type or social deprivation index. Additional research is needed to understand the factors that lead to blood pressure reduction in community health center settings.