Abstract P3163: Social Determinants of Health Among Rural Underserved Patients with Uncontrolled Hypertension

Abstract

Introduction: Hypertension remains one of the most prevalent chronic conditions in the United States, with significant racial and ethnic disparities. Similar disparities are also seen among individuals with lower socioeconomic status and individuals living in rural versus urban locations. Understanding how specific social determinants of health contribute to these gaps could address the growing burden of hypertension among high-risk populations. Hypothesis: To investigate specific social determinants of health associated with uncontrolled hypertension among rural, underserved patients residing in Alabama. Methods: A retrospective review of EHR data of patients from the UAB Selma Family Medicine clinic was conducted. The de-identified data was then entered into the Population Health Assessment Engine (PHATE) to render social characteristics and Community Vital Sign (CVS) scores, a social deprivation index, by census tracts for each patient. We provide descriptive statistics and compare the stated factors between patients with controlled and uncontrolled hypertension using logistic regression models. Results: Among 2129 patients, 375 (17.6%) had uncontrolled hypertension with a mean age of 58.7 ± 14.4 years. Women represented 66.7% (250) and 65.1% (1142) of the uncontrolled and controlled hypertension populations, respectively. The prevalence of uncontrolled hypertension was 19.1% among Black patients and 8.2% in White patients. Patients with uncontrolled hypertension had a CVS of 82.37 ± 7.31 and 81.81 ± 8.40 patients with controlled hypertension. Patients with uncontrolled hypertension lived in areas where an average of 46 ± 11% of the population was not employed, 36 ± 9% lived in rental housing, and 28 ± 1% lived below the federal poverty line (FPL). Adjusting for age, race, and sex, a unit increase in the proportion of people below the FPL was associated with 43% higher odds of uncontrolled versus controlled hypertension (OR = 1.43, 95% CI 0.44, 4.64). A unit increase in the percentage of single-parent households was associated with 78% higher odds (OR = 1.78, 95% CI 0.44, 7.22), but a unit increase in the percentage of people without a high school diploma was associated with 29% lower odds of uncontrolled versus controlled hypertension (OR = 0.71, 95% CI 0.08, 6.68). Conclusions: Rural, underserved patients with hypertension experience multiple adverse social determinants that may be important to address when caring for this population.