Abstract 4371808: Insurance-Related Disparities in Antihypertensive Treatment Among U.S. Adults: A Decade-Long NHANES Analysis (2013–2022)

Abstract

Background: Hypertension remains the most prevalent modifiable risk factor for cardiovascular disease. Although national access to care has improved, disparities in antihypertensive treatment by insurance type remain poorly defined in recent population-level data. Methods: We conducted a pooled cross-sectional analysis of U.S. adults aged ≥18 years using National Health and Nutrition Examination Survey (NHANES) data from 2013–2022. Adults who self-reported a physician diagnosis of hypertension were included. The primary outcome was current use of prescription antihypertensive medication. Insurance type was classified as Medicare (reference), Medicaid, Private, or Uninsured. Treatment prevalence was estimated using survey-weighted proportions. We then performed logistic regression accounting for NHANES survey design. To adjust for confounding, we applied inverse probability of treatment weighting (IPTW) based on a multinomial propensity score model including age, sex, race/ethnicity, education, and income. Results: Among 4,333 adults with diagnosed hypertension, treatment rates were highest in Medicare (91.5%) and lowest among the Uninsured (61.5%). In survey-weighted models, the odds of receiving treatment were significantly lower for Medicaid (OR 0.23; 95% CI 0.15–0.38), Private (OR 0.27; 95% CI 0.20–0.35), and Uninsured (OR 0.15; 95% CI 0.11–0.24) groups compared to Medicare. IPTW-adjusted models yielded consistent findings: Medicaid (OR 3.50; p=0.024) and Private (OR 4.25; p=0.0018) groups had significantly higher odds of being untreated. The Uninsured group showed a trend toward undertreatment (OR 1.58), but this was not statistically significant (p=0.33). Conclusion: Despite national improvements in insurance coverage, significant disparities in hypertension treatment persist. Adults with Medicaid and private insurance are at substantially higher risk of being untreated compared to Medicare recipients, even after adjustment for sociodemographic factors. The Uninsured group demonstrated a consistent but non-significant trend toward undertreatment. These findings highlight the urgent need for targeted, insurance-sensitive interventions to promote equitable hypertension care.