Research ArticleOriginal Research

Disparities in Hypertension Control Across and Within Three Health Systems Participating in a Data-Sharing Collaborative

Kevin Selby, Martha Michel, Ginny Gildengorin, Leah Karliner, Rajiv Pramanik, Valy Fontil and Michael B. Potter
The Journal of the American Board of Family Medicine November 2018, 31 (6) 897-904; DOI: https://doi.org/10.3122/jabfm.2018.06.180166

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Figures

  • Figure 1.
    Figure 1.

    Probability of hypertensive patients at each practice having uncontrolled blood pressure at their most recent primary care visit. Information taken from electronic health records of all patients with ≥1 primary care visit over 2 years. Model adjusted for patient age, sex, race/ethnicity, insurance, obesity, smoking status, preferred language, number of primary care visits, and presence of comorbidities (cardiovascular disease, diabetes mellitus and chronic kidney disease). Error bars represent 95% CIs (n = 51,417). The vertical axis shows proportion of patients with hypertension, and the horizontal axis shows data for clinics within each health system. CI, confidential interval; Clin, Clinic.

Tables

  • Table 1.

    Descriptive Characteristics of Patients with Hypertension in Three Health Systems

    CharacteristicHealth System 1, n (%)Health System 2, n (%)Health System 3, n (%)Total, n (%)
    n17,92313,93721,27353,133
    Age categories
        18 to 39 years851 (5)1,072 (8)2,024 (10)3,847 (7)
        40 to 59 years7,264 (41)4,926 (35)10,514 (49)22,704 (43)
        60 to 85 years9,808 (55)7,939 (57)8,743 (41)26,482 (50)
    Female sex8,880 (50)7,317 (53)12,076 (57)28,273 (53)
    Race/ethnicity
        Non-Latino White3,214 (18)5,848 (42)6,197 (29)15,250 (30)
        African-American4,118 (23)1,838 (13)5,088 (24)11,044 (21)
        Latino3,113 (17)1047 (8)4,581 (22)8,741 (17)
        Asian/Pacific Islander5,976 (33)3,807(27)4,420 (21)14,203 (27)
        American Indian or Alaska Native302 (2)24 (0)132 (1)458 (1)
        Other or unknown1,200 (7)1,373 (10)855 (4)3,428 (6)
    Preferred language
        English10,560 (59)11,661 (84)15,376 (72)3,7597 (71)
        Spanish2,569 (14)356 (3)2,916 (14)5,841 (11)
        Chinese2,832 (16)823 (6)264 (1)3,919 (7)
        Other*1,911 (11)1,097 (8)2,714 (13)5,722 (11)
    Insurance
        Commercial1,241 (7)6,815 (49)6,117(29)14,173 (27)
        Medicaid or local county coverage10,701 (60)2,179 (16)10,252 (48)23,132 (44)
        Medicare5,177 (29)4,782 (34)3,826 (18)13,785 (26)
        No health coverage804 (4.5)161 (1.2)1,078 (5.1)2,043 (8)
    Body mass index in kg/m2
        Less than 254,705 (26)4,327 (31)3,787 (18)12,819 (24)
        25 to less than 305,832 (33)4,794 (34)6,181 (29)16,807 (32)
        30 or greater6,803 (38)4,638 (33)10,475 (49)21,916 (41)
    Current smoker3,811 (21)996 (10)4,457 (21)9,264 (19)
    Comorbidities
        Chronic kidney disease2,246 (13)1,845 (13)2,943 (9)6,023 (11)
        Diabetes mellitus6,207 (35)4,111 (30)7,803 (37)18,121 (34)
        Cardiovascular disease3,399 (19)2,620 (19)2,350 (11)8,369 (16)
    Number of primary care visits during 2-year period
        1 to 2 visits2,493 (14)1,385 (10)2,250 (11)6,128 (12)
        3 to 4 visits3,191 (18)1,705 (12)2,791 (13)7,687 (14)
        5 or more12,153 (68)10,847 (78)16,232 (76)39,232 (74)
    Blood pressure not controlled at last visit5,110 (29)4,337 (31)9,304 (44)18,751 (35)

    • Information taken from electronic health records of all patients with ≥1 primary care visit over 2 years.

    • P-values for all comparisons between systems were < .01 using χ2 tests.

    • ↵* Most frequent other languages were Tagalog (n = 1,070), Vietnamese (n = 840), Russian (n = 673), Punjabi (n = 390), Farsi (n = 247), and Arabic (n = 210).

  • Table 2.

    Descriptive Characteristics of Patients with Controlled and Uncontrolled Blood Pressure on the Day of their Last Primary Care Visit (n = 53,133)

    CharacteristicControlled, n (%)Uncontrolled, n (%)
    n34,38218,751
    Age categories
        18 to 39 years2150 (6)1797 (10)
        40 to 59 years13,520 (39)9184 (49)
        60 to 85 years18,712 (54)7770 (41)
    Female sex18,529 (54)9744 (52)
    Race/ethnicity
        Non-Latino white9805 (29)5454 (29)
        African-American6304 (18)4740 (25)
        Latino5595 (16)3146 (17)
        Asian/Pacific Islander10,404 (30)4257 (23)
        Native American316 (1)142 (1)
        Other or unknown1958 (6)1,012 (5)
    Language
        English23,607 (69)13,990 (75)
        Spanish3842 (11)1999 (11)
        Cantonese or Mandarin3125 (9)794 (4)
        Others3775 (11)1947 (10)
    Insurance
        Insured or other health coverage33,443 (97)17,872 (95)
        No health coverage1063 (3)980 (5)
    Body mass index (kg/m2)
        Less than 258949 (27)5759 (32)
        25 to less than 3014,411 (43)7134 (40)
        30 or greater13,353 (40)8563 (48)
    Current smoker5289 (17)3975 (23)
    Number of primary care visits during 2-year period
        1 to 2 visits3212 (9)2916 (16)
        3 to 4 visits4761 (14)2926 (16)
        5 or more visits26,361 (77)12,871 (69)
    Comorbidities
        Chronic kidney disease3811 (11)2212 (12)
        Diabetes mellitus11,490 (33)6631 (35)
        Cardiovascular disease5516 (16)2853 (15)
    Health system
        Health System 112,813 (37)5110 (27)
        Health System 29600 (28)4337 (23)
        Health System 311,969 (35)9304 (50)

    • Information taken from electronic health records of all patients with ≥1 primary care visit over 2 years.

    • P-values for all comparisons between controlled and uncontrolled hypertension were < .01 using χ2 tests.

  • Table 3.

    Multivariate Model of Risk of Uncontrolled Blood Pressure at the Most Recent Primary Care Visit

    CharacteristicRisk Ratio (95% CI)
    Sex
        Male (reference)1.0
        Female0.98 (0.96 to 1.01)
    Age/Comorbidity category*
        Aged >60 years with no comorbidities (reference)1.0
        Aged > 60 years with comorbidities1.64 (1.57 to 1.71)
        Aged <60 years with no comorbidities1.72 (1.65 to 1.79)
        Aged <60 years with comorbidities1.51 (1.45 to 1.58)
    Race/ethnicity
        Non-Latino white (reference)1.0
        African American1.13 (1.09 to 1.16)
        Latino1.01 (0.96 to 1.05)
        Asian/Pacific Islander0.95 (0.91 to 0.98)
        American Indian, other, or unknown0.99 (0.93 to 1.04)
    Preferred language
        English (reference)1.0
        Spanish0.97 (0.92 to 1.02)
        Cantonese or Mandarin0.79 (0.73 to 0.85)
        Other language1.05 (1.01 to 1.10)
    Insurance status
        No health coverage (reference)1.0
        Insured or other health coverage0.87 (0.83 to 0.92)
    Smoking status
        Never or past smoker (reference)1.0
        Current smoker1.12 (1.08 to 1.15)
    Body mass index (BMI)
        Not overweight or obese (BMI<25 kg/m2) (reference)1.0
        Overweight (BMI 25 to <30 kg/m2)1.02 (0.99 to 1.06)
        Obese (BMI > 30 kg/m2)1.09 (1.06 to 1.13)
    Number of primary care visits over 2-year period
        1 to 2 visits (reference)1.0
        3 to 4 visits0.85 (0.82 to 0.88)
        5 or more visits0.71 (0.69 to 0.73)
    Health System
        Health System 1 (reference)1.0
        Health System 21.15 (1.11 to 1.19)
        Health System 31.46 (1.42 to 1.50)

    • BMI, body mass index; CI, confidential interval.

    • Only patients with complete data were included (n = 51,417).

    • Statistically significant risk ratio differences in comparison to reference variables are displayed in bold type.

    • ↵* Comorbidities relevant to blood pressure target chronic kidney disease, diabetes, ans cardiovascular disease.

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