Abstract P2160: Exploring Racial and Ethnic Disparities in the Social Determinants of Health among Participants in a Hypertension Prevention Trial, the LINKED-BP Program

Abstract

Background: Hypertension (HTN) remains a highly prevalent risk factor for cardiovascular disease. To reduce the burden of HTN and advance health equity, social determinants of health (SDOH) should be assessed and addressed. Methods: The LINKED-BP Program is an American Heart Association-funded cluster-randomized pragmatic trial among adults with elevated blood pressure (BP) or stage 1 HTN. Participants have been recruited from two community-based health systems in Maryland. The LINKED-BP Program compares the effectiveness of support from community health workers and home blood pressure (HMBP) telemonitoring via a mobile app to enhanced usual care with HMBP in preventing progression to stage 2 HTN. We used the Accountable Health Communities Health-Related Social Needs Screening Tool to measure SDOH through telephone-administered surveys in English or Spanish. SDOH factors were compared among non-Hispanic Black, non-Hispanic White, and Hispanic adults using chi-square tests. Statistical significance was set at p<0.05. Results: Among 325 adults, the mean age was 43.1 (±12.7) years, 66% were female, 18% were Hispanic, 32% were non-Hispanic Black, and 47% were non-Hispanic White. Hispanic adults had lower education levels: 32% had <high school education, compared to 11% among non-Hispanic Black and 5% non-Hispanic White adults, p<0.001. Hispanic adults were overrepresented in the lower annual household income category: 33% earn ≤ $39,999 vs. 22% non-Hispanic Black and 14% non-Hispanic White adults, p=0.009. Similarly, transportation needs were greatest among Hispanic adults: 19% vs. 13% of non-Hispanic Black and 5% non-Hispanic White adults, p=0.007. Conclusions: Racial and ethnic disparities in SDOH were evident among LINKED-BP participants, with Hispanic adults experiencing the highest burden, and non-Hispanic White adults the lowest. Lower education, income, and transportation access have potential negative impacts on HTN prevention because they could limit access to care, relevant health information, and medical devices (e.g., BP devices). Interventions to prevent HTN should prioritize addressing SDOH factors to achieve desired cardiovascular health outcomes and promote health equity.