Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware

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Author(s)Baker-Smith, Carissa M.
Author(s)Yang, Wei
Author(s)McDuffie, Mary J.
Author(s)Nescott, Erin P.
Author(s)Wolf, Bethany J.
Author(s)Wu, Cathy H.
Author(s)Zhang, Zugui
Author(s)Akins, Robert E.
Date Accessioned2023-05-04T18:17:37Z
Date Available2023-05-04T18:17:37Z
Publication Date2023-03-15
DescriptionThis article was originally published in Jama Network Open. The version of record is available at: https://doi.org/10.1001/jamanetworkopen.2023.3012. This is an open access article distributed under the terms of the CC-BY License. © 2023 Baker-Smith CM et al. JAMA Network Open.
AbstractKey Points: Question: Is there an association between neighborhood measures of deprivation and hypertension diagnosis in youth? Findings: In this cross-sectional study of 65 452 Delaware Medicaid-insured youths aged 8 to 18 years between 2014 and 2019, residence in neighborhoods with a higher area deprivation index was associated with primary hypertension diagnosis. Meaning: These findings suggest that there is an association between greater neighborhood deprivation and a diagnosis of primary hypertension in youths, which may be an important factor to consider in assessing the presence and prevalence of hypertension in youths. Abstract: Importance: The association between degree of neighborhood deprivation and primary hypertension diagnosis in youth remains understudied. Objective: To assess the association between neighborhood measures of deprivation and primary hypertension diagnosis in youth. Design, Setting, and Participants: This cross-sectional study included 65 452 Delaware Medicaid-insured youths aged 8 to 18 years between January 1, 2014, and December 31, 2019. Residence was geocoded by national area deprivation index (ADI). Exposures: Higher area deprivation. Main Outcomes and Measures; The main outcome was primary hypertension diagnosis based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Data were analyzed between September 1, 2021, and December 31, 2022. Results: A total of 65 452 youths were included in the analysis, including 64 307 (98.3%) without a hypertension diagnosis (30 491 [47%] female and 33 813 [53%] male; mean [SD] age, 12.5 (3.1) years; 12 500 [19%] Hispanic, 25 473 [40%] non-Hispanic Black, 24 565 [38%] non-Hispanic White, and 1769 [3%] other race or ethnicity; 13 029 [20%] with obesity; and 31 548 [49%] with an ADI ≥50) and 1145 (1.7%) with a diagnosis of primary hypertension (mean [SD] age, 13.3 [2.8] years; 464 [41%] female and 681 [59%] male; 271 [24%] Hispanic, 460 [40%] non-Hispanic Black, 396 [35%] non-Hispanic White, and 18 [2%] of other race or ethnicity; 705 [62%] with obesity; and 614 [54%] with an ADI ≥50). The mean (SD) duration of full Medicaid benefit coverage was 61 (16) months for those with a diagnosis of primary hypertension and 46.0 (24.3) months for those without. By multivariable logistic regression, residence within communities with ADI greater than or equal to 50 was associated with 60% greater odds of a hypertension diagnosis (odds ratio [OR], 1.61; 95% CI 1.04-2.51). Older age (OR per year, 1.16; 95%, CI, 1.14-1.18), an obesity diagnosis (OR, 5.16; 95% CI, 4.54-5.85), and longer duration of full Medicaid benefit coverage (OR, 1.03; 95% CI, 1.03-1.04) were associated with greater odds of primary hypertension diagnosis, whereas female sex was associated with lower odds (OR, 0.68; 95%, 0.61-0.77). Model fit including a Medicaid-by-ADI interaction term was significant for the interaction and revealed slightly greater odds of hypertension diagnosis for youths with ADI less than 50 (OR, 1.03; 95% CI, 1.03-1.04) vs ADI ≥50 (OR, 1.02; 95% CI, 1.02-1.03). Race and ethnicity were not associated with primary hypertension diagnosis. Conclusions and Relevance; In this cross-sectional study, higher childhood neighborhood ADI, obesity, age, sex, and duration of Medicaid benefit coverage were associated with a primary hypertension diagnosis in youth. Screening algorithms and national guidelines may consider the importance of ADI when assessing for the presence and prevalence of primary hypertension in youth.
SponsorConflict of Interest Disclosures: Dr Wolf reported receiving grants from the Delaware Clinical and Translational Research Program and the National Institutes of Health/National Center for Advancing Translational Sciences (U54GM104941) outside the submitted work. No other disclosures were reported. Funding/Support: Access to health care claims data was supported by an award from the Delaware Institutional Development Award (IDeA) Network of Biomedical Research Excellence (INBRE) Core Access Award under grant P20GM103446 from the National Institute of General Medical Sciences, National Institutes of Health. Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
CitationBaker-Smith CM, Yang W, McDuffie MJ, et al. Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware. JAMA Netw Open. 2023;6(3):e233012. doi:10.1001/jamanetworkopen.2023.3012
ISSN2574-3805
URLhttps://udspace.udel.edu/handle/19716/32723
Languageen_US
PublisherJama Network Open
TitleAssociation of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware
TypeArticle
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